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Combination of external beam radiotherapy and Californium (Cf)-252 neutron intracavity brachytherapy is more effective in control of cervical squamous cell carcinoma than that of cervical adenocarcinoma

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Abstract

The objective of this study was to compare the effect of combined external beam radiotherapy (EBRT) and Californium (Cf)-252 neutron intracavity brachytherapy (ICBT) on cervical squamous versus adenocarcinoma. A total of 106 patients with stage IB–IIIB cervical cancer were accrued between January 2005 and May 2011 and divided into squamous cell carcinoma (SCC) and adenocarcinoma (AC) as a pair with 53 patients in each group according to tumor size, stage, age, and hemoglobin level using matched-pair design. The whole pelvic EBRT was performed with 2 Gy/fraction, 4 fractions/week. The total dose was 48–54 Gy (the center of whole pelvic field was blocked by 4 cm in width after 20–36 Gy). Cf-252 neutron ICBT was delivered with 11 and 12 Gy-eq/f with the total dose at point A of 44 and 48 Gy-eq for SCC and AC patients, respectively. The mean follow-up time was 43 months. The 5-year LC, OS, DFS, LAC rates, and mean survival time were 66.0, 56.6, 52.8.0, 17.0 %, and 76.4 ± 6.2 months, respectively, for AC patients, whereas they were 81.1, 69.8, 67.9, 11.3 %, and 93.3 ± 4.3 months, respectively, for SCC patients. Furthermore, the early treatment toxicity was mild in both groups, the late treatment complications were mainly radiation-induced proctitis and cystitis, and there were no grade 3 or higher complications. Although the combination of Cf-252 neutron ICBT and EBRT was effective in both histology types of cervical cancer, a more aggressive strategy is needed to control cervical AC.

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References

  1. Jemal A, et al. Global cancer statistics. CA Cancer J Clin. 2011;61(2):69–90.

    Article  PubMed  Google Scholar 

  2. Mathew A, George PS. Trends in incidence and mortality rates of squamous cell carcinoma and adenocarcinoma of cervix–worldwide. Asian Pac J Cancer Prev. 2009;4(10):645–50.

    Google Scholar 

  3. Canavan TP, Doshi NR. Cervical cancer. Am Fam Physician. 2000;61(5):1369–76.

    CAS  PubMed  Google Scholar 

  4. Kumar V et al. Robbins basic pathology, 8th ed. New York: Saunders Elsevier; 2007. pp. 718–721.

    Google Scholar 

  5. Gien LT, Beauchemin MC, Thomas G. Adenocarcinoma: a unique cervical cancer. Gynecol Oncol. 2010;116(1):140–6.

    Article  CAS  PubMed  Google Scholar 

  6. Smith HO, et al. The rising incidence of adenocarcinoma relative to squamous cell carcinoma of the uterine cervix in the United States—a 24-year population-based study. Gynecol Oncol. 2000;78(2):97–105.

    Article  CAS  PubMed  Google Scholar 

  7. Sasieni P, Adams J. Changing rates of adenocarcinoma and adenosquamous carcinoma of the cervix in England. The Lancet. 2001;357(9267):1490–3.

    Article  CAS  Google Scholar 

  8. Mabuchi S, et al. Impact of histological subtype on survival of patients with surgically-treated stage IA2-IIB cervical cancer: adenocarcinoma versus squamous cell carcinoma. Gynecol Oncol. 2012;127(1):114–20.

    Article  PubMed  Google Scholar 

  9. Green JA, et al. Survival and recurrence after concomitant chemotherapy and radiotherapy for cancer of the uterine cervix: a systematic review and meta-analysis. The Lancet. 2001;358(9284):781–6.

    Article  CAS  Google Scholar 

  10. Rose PG. Are the differences in treatment outcome for adenocarcinoma of the cervix different enough to change the treatment paradigm? Gynecol Oncol. 2012;125(2):285–6.

    Article  PubMed  Google Scholar 

  11. Katanyoo K, Sanguanrungsirikul S, Manusirivithaya S. Comparison of treatment outcomes between squamous cell carcinoma and adenocarcinoma in locally advanced cervical cancer. Gynecol Oncol. 2012;125(2):292–6.

    Article  PubMed  Google Scholar 

  12. Kasamatsu T, et al. Radical hysterectomy for FIGO stage I–IIB adenocarcinoma of the uterine cervix. Br J Cancer. 2009;100(9):1400–5.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  13. Shinglefon HM, et al. Is there really a difference in survival of women with squamous cell carcinoma, adenocarcinoma, and adenosquamous cell carcinoma of the cervix? Cancer Cell. 1995;10(suppl 76):1948–55.

    Article  Google Scholar 

  14. Chen JL, et al. Differential clinical characteristics, treatment response and prognosis of locally advanced adenocarcinoma/adenosquamous carcinoma and squamous cell carcinoma of cervix treated with definitive radiotherapy. Acta Obstet Gynecol Scand. 2014;93(7):661–8.

    Article  PubMed  Google Scholar 

  15. Huang YT, et al. Long-term outcome and prognostic factors for adenocarcinoma/adenosquamous carcinoma of cervix after definitive radiotherapy. Int J Radiat Oncol Biol Phys. 2011;80(2):429–36.

    Article  PubMed  Google Scholar 

  16. Wakatsuki M, et al. Clinical outcomes of carbon ion radiotherapy for locally advanced adenocarcinoma of the uterine cervix in phase 1/2 clinical trial (protocol 9704). Cancer. 2014;120(11):1663–9.

    Article  PubMed  Google Scholar 

  17. Maruyama Y, et al. A review of californium-252 neutron brachytherapy for cervical cancer. Cancer. 1991;68(6):1189–97.

    Article  CAS  PubMed  Google Scholar 

  18. Gong L, et al. Clonal status and clinicopathological observation of cervical minimal deviation adenocarcinoma. Diagn Pathol. 2010;5(1):25.

    Article  PubMed Central  PubMed  Google Scholar 

  19. Lea JS, et al. Adenosquamous histology predicts poor outcome in low-risk stage IB1 cervical adenocarcinoma. Gynecol Oncol. 2003;91(3):558–62.

    Article  PubMed  Google Scholar 

  20. Nakano T, et al. Carbon beam therapy overcomes the radiation resistance of uterine cervical cancer originating from hypoxia. Clin Cancer Res. 2006;12(7 Pt 1):2185–90.

    Article  CAS  PubMed  Google Scholar 

  21. Lei X, et al. Californium-252 brachytherapy combined with external-beam radiotherapy for cervical cancer: long-term treatment results. Int J Radiat Oncol Biol Phys. 2011;81(5):1264–70.

    Article  PubMed  Google Scholar 

  22. Tacev T, Ptkov B, Strnad V. Californium-252 (252Cf) versus conventional gamma radiation in the brachytherapy of advanced cervical carcinoma long-term treatment results of a randomized study. Strahlenther Onkol. 2003;179(6):377–84.

    PubMed  Google Scholar 

  23. Bidmead M. Dose and volume specification for reporting intracavitary therapy in gynecology. ICRU report 38. Washington: ICRU; 1985.

    Google Scholar 

  24. Maruyama Y, et al. Neutron brachytherapy is better than conventional radiotherapy in advanced cervical cancer. Lancet. 1985;1(8438):1120–2.

    Article  CAS  PubMed  Google Scholar 

  25. van Nagell JR, et al. Phase II clinical trial using californium 252 fast neutron brachytherapy, external pelvic radiation, and extra fascial hysterectomy in the treatment of bulky, barrel-shaped stage IB cervical cancer. Cancer. 1986;57(10):1918–22.

    Article  PubMed  Google Scholar 

  26. Zhang M, et al. Low-dose-rate californium-252 neutron intracavitary after loading radiotherapy combined with conformal radiotherapy for treatment of cervical cancer. Int J Radiat Oncol Biol Phys. 2012;83(3):966–71.

    Article  PubMed  Google Scholar 

  27. Maruyama Y, et al. Five-year cure of cervical cancer treated using californium-252 neutron brachytherapy. Am J Clin Oncol. 1984;5(7):487–93.

    Article  Google Scholar 

  28. Grigsby PW, et al. Adenocarcinoma of the uterine cervix: lack of evidence for a poor prognosis. Radiother Oncol. 1988;12(4):289–96.

    Article  CAS  PubMed  Google Scholar 

  29. Niibe Y, et al. High-dose-rate intracavitary brachytherapy combined with external beam radiotherapy for stage IIIb adenocarcinoma of the uterine cervix in japan: a multi-institutional study of Japanese Society of Therapeutic Radiology and Oncology 2006–2007. Jpn J Clin Oncol. 2010;40(8):795–9.

    Article  PubMed  Google Scholar 

  30. Raju MR, et al. A heavy particle comparative study. Part III: OER and RBE. Br J Radiol. 1978;51:712–9.

    Article  CAS  PubMed  Google Scholar 

  31. van Nagell JR, et al. Phase II clinical trial using californium 252 fast neutron brachytherapy, external pelvic radiation, and extra fascial hysterectomy in the treatment of bulky, barrel-shaped stage IB cervical cancer. Cancer. 1986;10(57):1918–22.

    Article  Google Scholar 

  32. Das D, et al. Treatment of cervical carcinoma with high-dose rate intracavitary brachytherapy: two years follow-up study. Asian Pac J Cancer Prev. 2011;12:807–10.

    PubMed  Google Scholar 

  33. Buranawit K, et al. The treatment outcome of adenocarcinoma of uterine cervix at Phramongkutklao Hospital. J Med Assoc Thai. 2010;93(Suppl 6):S13–21.

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Cancer Center, Daping Hospital and Research Institution of Surgery, Third Military Medical University, No. 10 Changjiang Zhi Rd, Yuzhong District, Chongqing, 400042, China

    Yanli Xiong, Jia Liu, Shu Chen, Qian Zhou, Wenjing Xu, Chen Tang, Yonghong Chen, Mei Yang & Xin Lei

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  1. Yanli Xiong
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  2. Jia Liu
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  3. Shu Chen
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  4. Qian Zhou
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  6. Chen Tang
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  7. Yonghong Chen
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  9. Xin Lei
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Correspondence to Xin Lei.

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Our study has been approved by the appropriate ethics committee and has been performed in accordance with the ethical standards laid down in 1964 Declaration of Helsinki and its later amendments.

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All persons have given their informed consent prior to their inclusion in the study.

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Yanli Xiong is the first author.

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Xiong, Y., Liu, J., Chen, S. et al. Combination of external beam radiotherapy and Californium (Cf)-252 neutron intracavity brachytherapy is more effective in control of cervical squamous cell carcinoma than that of cervical adenocarcinoma. Med Oncol 32, 231 (2015). https://doi.org/10.1007/s12032-015-0670-3

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  • DOI: https://doi.org/10.1007/s12032-015-0670-3

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