Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
SHR Neuro Krebs Kardio Lipid Stoffw Microb
Kapp, KS; Poschauko, J; Tauss, J; Berghold, A; Oechs, A; Lahousen, M; Petru, E; Winter, R; Kapp, DS.
Analysis of the prognostic impact of tumor embolization before definitive radiotherapy for cervical carcinoma.
Int J Radiat Oncol Biol Phys. 2005; 62(5):1399-1404
Doi: 10.1016/j.ijrobp.2004.12.037
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- Führende Autor*innen der Med Uni Graz
- Kapp Karin S.
- Co-Autor*innen der Med Uni Graz
- Berghold Andrea
- Lahousen Manfred
- Petru Edgar
- Tauss Josef
- Winter Raimund
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- Abstract:
- To assess whether embolization compromises the radiocurability of primary cervical cancer. Two hundred fifty-four patients with primary cervical cancer (International Federation of Gynecology and Obstetrics [FIGO] stages IB: 47; II: 91; IIIB: 102; IV: 14) were treated with external beam irradiation and Ir-192 high-dose-rate brachytherapy over a period of 15 years. Of these, 24 patients (9.4%) (FIGO stages IB: 1; II: 8; IIIB: 12; IV: 3) had had bilateral embolization of the internal iliac arteries before referral. The median age of the entire cohort was 66 years (range, 34-85 years). Tumor size was >5 cm and paraortic nodes were enlarged (> or =1 cm) on pretreatment CAT scan in 39.4% and 9.1% of patients, respectively. All patients with hemoglobin levels (hb-l) < or =11 g/dL (28.3%) received packed red cell transfusions (PRCT) before and/or during radiotherapy in an attempt to maintain levels >11 g/dL throughout treatment. Cross-table tests were used to compare the distribution of FIGO stage, tumor size, lymph node status, and pretreatment and treatment hb-l of embolized and nonembolized patients. The impact of embolization, along with the above-listed tumor characteristics, on disease-specific survival (DSS), pelvic control (PC), and distant metastases-free survival (MFS) was determined by univariate and multivariate analyses. Embolized patients presented at a statistically significant younger median age (55 vs. 67 years; p = 0.003), with larger tumors (66.7% vs. 36.5%; p = 0.007), and lower pretreatment hb-l (75% vs. 23.5%; p < 0.001) than nonembolized patients. There was no significant difference in stage distribution or lymph node status, and although embolized patients responded better to PRCT (50% vs. 29.6%), this difference was not statistically significant. Univariate analysis showed a trend toward decreased DSS (p = 0.09) and PC (p = 0.07) for embolized patients but no effect on MFS, whereas all other variables tested were significantly correlated with DSS, PC, and MFS (all p < 0.001). In the multivariate model, tumor embolization, FIGO stage, and pretreatment hb-l ceased to impact significantly on outcome. Tumor size remained the most powerful independent predictor for all endpoints tested, followed by treatment hb-l. Paraortic node status was significantly correlated with DSS and MFS. Although a trend toward poorer DSS and PC was observed in embolized patients, no impact on radiocurability could be demonstrated in multivariate analysis after controlling for the major tumor characteristics and treatment hb-l.
- Find related publications in this database (using NLM MeSH Indexing)
- Adenocarcinoma - blood
- Adenocarcinoma - complications
- Adenocarcinoma - radiotherapy
- Adult -
- Aged -
- Aged, 80 and over -
- Analysis of Variance -
- Anemia - therapy
- Carcinoma, Squamous Cell - blood
- Carcinoma, Squamous Cell - complications
- Carcinoma, Squamous Cell - radiotherapy
- Disease-Free Survival -
- Embolization, Therapeutic -
- Erythrocyte Transfusion -
- Female -
- Humans -
- Iridium Radioisotopes - therapeutic use
- Middle Aged -
- Prognosis -
- Retrospective Studies -
- Uterine Cervical Neoplasms - blood
- Uterine Cervical Neoplasms - complications
- Uterine Cervical Neoplasms - radiotherapy
- Uterine Hemorrhage - blood
- Uterine Hemorrhage - etiology
- Uterine Hemorrhage - therapy
- Find related publications in this database (Keywords)
- cervical cancer
- radiotherapy
- embolization
- prognostic factors
- anemia