Neoadjuvant Chemotherapy in the Treatment of Cervical Cancer
Notice bibliographique
Résumé
While surrogate markers of treatment effectiveness might suggest neoadjuvant chemotherapy is of benefit, what is of greatest interest to patients and clinicians is whether neoadjuvant chemotherapy confers a survival advantage. The following studies, presented individually and later analyzed collectively, sought to compare patients receiving neoadjuvant chemotherapy prior to surgery versus surgery alone. All patients underwent a staging laparotomy. If the tumour was found to be resectable, a radical hysterectomy, with para-aortic lymphadenectomy, was performed, followed by whole pelvis radiotherapy (50 Gy). Conversely, if the cancer was found to be unresectable, patients received 50-60 Gy to the whole pelvis followed by 25-35 Gy of intracavitary treatment. Two hundred and five patients were randomized, 102 to neoadjuvant chemotherapy and 103 to the control arm. For all patients, improved overall survival was noted in those receiving neoadjuvant chemotherapy compared to controls (81% vs. 66% at 8 years, p = 0.05). While pathologic risk factors such as lymph node metastases (19% vs. 2%, p = 0.04) and vascular space invasion (38% vs. 2%, p = 0.007) were significantly improved in patients with stage IB1 disease receiving neoadjuvant chemotherapy, there was no difference in overall survival at 8 years in this subgroup (82% with neoadjuvant chemotherapy versus 77% control). Patients with stage IB2 disease, however, demonstrated improved overall survival following neoadjuvant chemotherapy (80% versus 61% at 9 years, p < 0.01). This benefit was driven by an increased rate of operability (100% (61/61) versus 86% (48/56), p < 0.01) and possibly an improvement in pathologic risk factors in those receiving neoadjuvant chemotherapy compared to controls. Of all patients with resectable tumours, greater survival was noted in those who had received neoadjuvant chemotherapy (81% vs. 69% at 7 years, p = 0.05). The incidence of high-risk pathologic features was similar between controls and patients who did not respond to neoadjuvant chemotherapy. In those who responded, however, there were significantly fewer with lymph node metastases (6% vs. 40%, p < 0.0001), vascular space invasion (10% vs. 60%, p = 0.009) and parametrial involvement (2% vs. 34%, p = 0.001). Neoadjuvant chemotherapy appeared beneficial in decreasing the incidence of pelvic recurrences for those patients with stage IB2 disease (23% vs. 6%, p < 0.01). However, rates of distant metastases were the same for stage IB patients overall. The authors concluded that in patients with stage IB1 disease there was no difference in operability or survival, and minimal difference in pathologic features, suggesting limited benefit of neoadjuvant chemotherapy in this patient population. However, patients with stage IB2 disease had a significant increase in operability, and survival. While offering an alternative to radical radiotherapy in patients with stage IB2 disease, all patients in this study underwent adjuvant radiotherapy. Therefore, those receiving neoadjuvant chemotherapy underwent triple modality treatment in order to derive benefit. How their survival would compare to the current standard treatment of chemoradiotherapy is also unclear. There were methodological issues in this study; violation of intention-to-treat analysis took place, with the exclusion of 3 control and 2 neoadjuvant www.intechopen.com
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».