Extended-field versus Whole-pelvis Concurrent Chemoradiation for Locally-advanced Cervical Cancer Patients with Radiologic Negative Para-aortic Lymph Node: A Systematic Review
Bibliographic record
Abstract
Extended-field versus Whole-pelvis Concurrent Chemoradiationfor Locally-advanced Cervical Cancer Patients with Radiologic NegativePara-aortic Lymph Node: A Systematic ReviewSangkittipaiboon S, Sukhaboon J*Bureau of Academic Medicine, Department of Medical Services, Ministry of Public Health, Talad Khwan,Mueang Nonthaburi, Nonthaburi, 11000**Lopburi Cancer Hospital, Mueang Lop Buri, Lopburi, 15000(E-mail: somphob87@gmail.com)บทคดยอ: การทบทวนอยางเปนระบบเพอศกษาผลการรกษามะเรงปากมดลกระยะลกลามทมผลเอกซเรยตอมนำเหลองพาราเอออรตกเปนลบจากการใหรงสรกษาแบบครอบคลมถงตอมนำเหลองบรเวณดงกลาวเปรยบเทยบกบการใหรงสรกษาบรเวณองเชงกรานโดยรวมกบการใหยาเคมบำบดสมภพ แสงกตตไพบลย พ.บ.*, จรศกด สขาบรณ พ.บ.***สำนกวชาการแพทย กรมการแพทย กระทรวงสาธารณสข ตำบลตลาดขวญ อำเภอเมอง จงหวดนนทบร 11000**โรงพยาบาลมะเรงลพบร อำเภอเมองลพบร จงหวดลพบร 15000Abstract Background: To review the role of extended-field concurrent chemoradiation (EF-CCRT) for locally-advanced cervical cancer patients with radiologic negative para-aortic lymph node and the complications resulting from the treatment compared with whole-pelvis concurrent chemoradiation (WP-CCRT). Methods: The information was searched from Medline, Embase, and Cochrane Library Databases to September2016. All randomized controlled trials (RCT) and cohort studies related to locally-advanced cervical cancer patients with radiologic negative para-aortic lymph node which compared EF-CCRT and standard WP-CCRT with weekly cisplatin were selected. Risk of bias assessment was performed using the Cochrane Collaboration’s tool, and quality assessment forcohort studies using the Newcastle-Ottawa quality scale. Information on trial design, population, disease status, interventions, median follow-up time, and outcomes were reported. Results: Finally, one RCT and two comparative cohort studies containing 381 patients were included. Significant heterogeneity among the studies precluded meta-analysis. Results of this review showed outcomes of the RCT: pelvic failure was 7.9% VS 8.3% (p = 0.8), para-aortic failure was 5.3% VS 25% (p = 0.02), distant metastatic failure was 13.2% VS 30.6% (p = 0.04), 5-yr overall survival (OS) rate was 72.4% VS 60.4% (p = 0.04), 5-yr disease-free survival (DFS) rate was 80.3% VS 69.1% (p= 0.03), acute grade3-4 hematologic toxicity rate was 5.2% VS 5.4% (p = 0.7), acute grade 3 - 4 non-hematologic toxicity rate was 2.6% VS 2.7% (p = 0.7), and late grade 3-4 toxicity rate was 2.6% VS 2.8% (p = 0.8) in EF-CCRT group compared with WP-CCRT group. The outcomes of one cohort study with significant differences in patient and tumor characteristics showed multivariate analysis between EF-CCRT group and WP-CCRT group: pelvic failure, HR = 1.1, 95% CI: 0.60 - 2.0, p = 0.72; para-aortic failure, HR = 2.01, 95% CI: 0.79 - 5.12, p = 0.14; distant metastaticfailure, HR = 1.9, 95% CI: 1.03-3.4, p = 0.039; 3-yr OS rate, HR =1.56, 95% CI: 0.90 - 2.69, p = 0.11; 3-yr DFS rate, HR = 1.08, 95%CI: 0.66 - 1.78, p = 0.75; and late grade 3-4 toxicity rate, HR = 1.39, 95% CI: 0.58 - 3.37, p = 0.47. The outcomes of another cohort study with historical control: 3-yr pelvic relapse-free survival rate was 90% VS 86% (p = 0.57), paraaortic lymph node relapse rate was 0% VS 46.8% (p = 0.02), distant metastatic-free survival rate was 79% VS 57% (p = 0.01), OS rate was 87% VS 62% (p = 0.02), and DFS rate was 82% VS54% (p = 0.02) in EF-CCRT group compared with WP-CCRT group.Acute gastrointestinal, genitourinary and myelotoxicities grade 3 - 4 of the study cohort were seen in 2 (6.2%), 1 (3.1%), and 18 (56%) patients, respectively. Late grade 3 - 4 gastrointestinal / genitourinary toxicities in the study and control cohorts were 3.1% / 3.1% and 6.4% / 4.3%, respectively. Conclusions: EF-CCRT with weekly cisplatin is as effective as WP-CCRT to control loco-regional disease with acceptable treatmentrelated toxicities. It should be the appropriate approach forlocally-advanced cervical cancer patients with radiologicnegative para-aortic lymph node.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.006 | 0.022 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.010 | 0.011 |
| Bibliometrics | 0.005 | 0.005 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".