Cervical cancer in 2002 (n=500,000) (Developed and developing countries)
-
Upload
uriah-cruz -
Category
Documents
-
view
21 -
download
1
description
Transcript of Cervical cancer in 2002 (n=500,000) (Developed and developing countries)
![Page 1: Cervical cancer in 2002 (n=500,000) (Developed and developing countries)](https://reader035.fdocuments.net/reader035/viewer/2022070401/5681366d550346895d9dfb9c/html5/thumbnails/1.jpg)
Trial Concept Weekly VS Three Weekly Chemotherapy for Chemoradiation in Cervical Cancer
Dr Sarikapan Wilailak** Endorsed by the TGCS (Thai Gynecologic Cancer Society)
![Page 2: Cervical cancer in 2002 (n=500,000) (Developed and developing countries)](https://reader035.fdocuments.net/reader035/viewer/2022070401/5681366d550346895d9dfb9c/html5/thumbnails/2.jpg)
Cervical cancer in 2002 (n=500,000)(Developed and developing countries)
DEVELOPED COUNTRIES DEVELOPING COUNTRIES
SITEAttrib to HPV (%)
TOTAL cancers
Attrib to HPV
% all cancer
TOTAL cancers
Attrib to
HPV
% all cancer
CERVIX 100 83,400 83,400 1.7% 409,400 409,400 7.0%
Ferlay J et al. Globocan 2002. IARC 2004.
![Page 3: Cervical cancer in 2002 (n=500,000) (Developed and developing countries)](https://reader035.fdocuments.net/reader035/viewer/2022070401/5681366d550346895d9dfb9c/html5/thumbnails/3.jpg)
Cancer in Thailand, Vol.IV, 1998-2000: 2007
![Page 4: Cervical cancer in 2002 (n=500,000) (Developed and developing countries)](https://reader035.fdocuments.net/reader035/viewer/2022070401/5681366d550346895d9dfb9c/html5/thumbnails/4.jpg)
New cases / year: 6,243 New cases / year: 6,243
Deaths / year: 2,620 Deaths / year: 2,620
In Thailand, each day 7 women die from cervical
cancer
In Thailand, each day 7 women die from cervical
cancer
Ferlay J et al. Globocan 2002. IARC 2004
![Page 5: Cervical cancer in 2002 (n=500,000) (Developed and developing countries)](https://reader035.fdocuments.net/reader035/viewer/2022070401/5681366d550346895d9dfb9c/html5/thumbnails/5.jpg)
Concurrent chemoradiation
![Page 6: Cervical cancer in 2002 (n=500,000) (Developed and developing countries)](https://reader035.fdocuments.net/reader035/viewer/2022070401/5681366d550346895d9dfb9c/html5/thumbnails/6.jpg)
In 1999, the USNCI issued a statement that concurrent chemoradiation should be considered for all patients with advanced cervical cancer (based on 5 RCT: and recently Keys et al, Marris et al., Rose et al., Whitney et al., Peters et al.)
![Page 7: Cervical cancer in 2002 (n=500,000) (Developed and developing countries)](https://reader035.fdocuments.net/reader035/viewer/2022070401/5681366d550346895d9dfb9c/html5/thumbnails/7.jpg)
Meta analysis
of Concurrent Chemo RT
vs RT(18 RCT)
Chemoradiotherapy for cervical cancer meta-analysis collaboration. ‘J Clin Oncol 2008:26:5802-12
![Page 8: Cervical cancer in 2002 (n=500,000) (Developed and developing countries)](https://reader035.fdocuments.net/reader035/viewer/2022070401/5681366d550346895d9dfb9c/html5/thumbnails/8.jpg)
![Page 9: Cervical cancer in 2002 (n=500,000) (Developed and developing countries)](https://reader035.fdocuments.net/reader035/viewer/2022070401/5681366d550346895d9dfb9c/html5/thumbnails/9.jpg)
Nowadays, concurrent chemoradiation has become the gold standard treatment for locally advanced cervical cancer.
![Page 10: Cervical cancer in 2002 (n=500,000) (Developed and developing countries)](https://reader035.fdocuments.net/reader035/viewer/2022070401/5681366d550346895d9dfb9c/html5/thumbnails/10.jpg)
Weekly cisplatin
VS
Three weekly cisplatin
![Page 11: Cervical cancer in 2002 (n=500,000) (Developed and developing countries)](https://reader035.fdocuments.net/reader035/viewer/2022070401/5681366d550346895d9dfb9c/html5/thumbnails/11.jpg)
Weekly VS three weekly
Three weekly chemotherapy could save a considerable amount of resources
There has been no randomized study that compares the two types of chemotherapeutic administration mentioned.
![Page 12: Cervical cancer in 2002 (n=500,000) (Developed and developing countries)](https://reader035.fdocuments.net/reader035/viewer/2022070401/5681366d550346895d9dfb9c/html5/thumbnails/12.jpg)
Weekly VS three weekly
The question of interest in this proposal is whether weekly or three weekly chemotherapy for chemoradiation in locally-advanced cervical cancer is comparable in terms of efficacy, toxicities, and cost effectiveness.
![Page 13: Cervical cancer in 2002 (n=500,000) (Developed and developing countries)](https://reader035.fdocuments.net/reader035/viewer/2022070401/5681366d550346895d9dfb9c/html5/thumbnails/13.jpg)
Objectives
Primary objectives will be to determine: Progression-free survival Acute toxicities Cost effectiveness of the treatments
Secondary objectives will be to determine: Overall survival long-term toxicities Patterns of disease recurrence Acceptability of patients Patients’ quality of life
![Page 14: Cervical cancer in 2002 (n=500,000) (Developed and developing countries)](https://reader035.fdocuments.net/reader035/viewer/2022070401/5681366d550346895d9dfb9c/html5/thumbnails/14.jpg)
Inclusion criteria Stage IB2 to IVA Squamous and adenocarcinoma ECOG performance status 0-2 WBC ≥ 3.0 x 109/L and ANC ≥ 1.5 x 109/L Platelets ≥ 100 x 109/L Bilirubin ≤ 1.5 x UNL AST/ALT ≤ 2.5 x UNL Adequate renal function: creatinine ≤ 1.5 ? or
calculated creatinine clearance (CockCroft-Gault Formula) ≥60ml/min
No contraindication to the use of cisplatin Informed consent
![Page 15: Cervical cancer in 2002 (n=500,000) (Developed and developing countries)](https://reader035.fdocuments.net/reader035/viewer/2022070401/5681366d550346895d9dfb9c/html5/thumbnails/15.jpg)
Exclusion criteria High-risk histologies (adenosquamous, clear cell
etc) Neoadjuvant chemotherapy Previous pelvic radiotherapy Patients with other invasive malignancies, with the
exception of non-melanoma skin cancer, who had (or have) any evidence of the other cancer present within the last 5 years
Pregnancy Serious illness or medical condition that precludes
the safe administration of the trial treatment HIV positive
![Page 16: Cervical cancer in 2002 (n=500,000) (Developed and developing countries)](https://reader035.fdocuments.net/reader035/viewer/2022070401/5681366d550346895d9dfb9c/html5/thumbnails/16.jpg)
Study Design and procedure
multi-centre randomized phase III trial. Arm A: Weekly chemoradiation Arm B: Three weekly chemoradiation Standard radiation treatment will be given
in both arms The overall treatment time should not
exceed eight weeks.
![Page 17: Cervical cancer in 2002 (n=500,000) (Developed and developing countries)](https://reader035.fdocuments.net/reader035/viewer/2022070401/5681366d550346895d9dfb9c/html5/thumbnails/17.jpg)
In arm A, cisplatin will be given during the radiation at a dose of 40mg/m2 weekly for 6 doses, within 4 weeks of completion of all radiation treatment.
In arm B, cisplatin will be given during the radiation at a dose of 70mg/m2 three weekly for 3 doses, within 4 weeks of completion of all radiation treatment.
![Page 18: Cervical cancer in 2002 (n=500,000) (Developed and developing countries)](https://reader035.fdocuments.net/reader035/viewer/2022070401/5681366d550346895d9dfb9c/html5/thumbnails/18.jpg)
Outcomes
Primary outcomes: Progression-free survival rates Acute toxicity rate Cost effectiveness ratio of the treatments
Secondary outcomes: Overall survival rates long-term toxicity rate Patterns of disease recurrence Acceptability rate of patients Patients’ quality of life score