Gamze Melek AKSU, Aylin Fidan KORCUM, Mine GENÇ, Melek Nur YAVUZ, Taylan BÜKÜLMEZ, Beyza Şirin ÖZDEMİR

Does the Radiotherapy Technique Have an Impact on the Survival of Patients with Cervical Cancer?

OBJECTIVEConcurrent chemoradiotherapy is the primary treatment for patients with locally advanced cervicalcancer. We evaluated the treatment results and prognostic factors in patients treated with chemoradiation.METHODSWe retrospectively reviewed the records of 150 patients with locally advanced cervical cancer treatedwith curative chemoradiotherapy between 1999 and 2014 at our hospital.RESULTSThe median follow-up period was 37.5 months (range: 5.6–186 months). All patients received both externalbeam radiation therapy (EBRT) and intracavitary brachytherapy. EBRT was delivered with conventional2-dimensional radiotherapy or 3-dimensional conformal radiotherapy (3DCRT). Eighty-sevenpercent of patients received cisplatinum-based chemotherapy during EBRT. Total or nearly total remissionwas achieved in 72% of patients. With a median follow-up duration of 37.5 months, 29% of patientsdied, 13% of patients had local-regional recurrence, and 25% of patients had distant metastasis. The 2-,5-, and 10-year overall survival rates were 76%, 62%, and 47%, respectively, and the progression-freesurvival rates were 68%, 62%, and 58%, respectively. We evaluated prognostic factors for overall survivaland progression-free survival. The most important prognostic factor was the radiotherapy technique. Thesurvival curves were estimated by the Kaplan–Meier method, and differences were assessed using thelog-rank test; a p-value

PDF

___

Torre LA, Bray F, Siegel RL, Ferlay J, Lortet-Tieulent J, Jemal A. Global cancer statistics, 2012. CA Cancer J Clin 2015;65(2):87–108.
Christopherson WM, Parker JE. Relation of cervical cancer to early marriage and childbearing. N Engl J Med 1965;273:235–9.
Keighley E. Carcinoma of the cervix among prostitutes in a women’s prison. Br J Vener Dis 1968;44(3):254–5.
Bosch FX, Lorincz A, Muñoz N, Meijer CJ, Shah KV. The causal relation between human papillomavirus and cervical cancer. J Clin Pathol 2002;55(4):244–65.
Rose PG, Bundy BN, Watkins EB, Thigpen JT, Deppe G, Maiman MA, et al. Concurrent cisplatin-based radiotherapy and chemotherapy for locally advanced cervical cancer. N Engl J Med 1999;340(15):1144–53.
Peters WA 3rd, Liu PY, Barrett RJ 2nd, Stock RJ, Monk BJ, Berek JS, et al. Concurrent chemotherapy and pelvic radiation therapy compared with pelvic radiation therapy alone as adjuvant therapy after radical surgery in high-risk early-stage cancer of the cervix. J Clin Oncol 2000;18(8):1606–13.
Morris M, Eifel PJ, Lu J, Grigsby PW, Levenback C, Stevens RE, et al. Pelvic radiation with concurrent chemotherapy compared with pelvic and para-aortic radiation for high-risk cervical cancer. N Engl J Med 1999;340(15):1137–43.
Keys HM, Bundy BN, Stehman FB, Muderspach LI, Chafe WE, Suggs CL 3rd, et al. Cisplatin, radiation, and adjuvant hysterectomy compared with radiation and adjuvant hysterectomy for bulky stage IB cervical carcinoma. N Engl J Med 1999;340(15):1154–61.
Whitney CW, Sause W, Bundy BN, Malfetano JH, Hannigan EV, Fowler WC Jr, et al. Randomized comparison of fluorouracil plus cisplatin versus hydroxyurea as an adjunct to radiation therapy in stage IIB-IVA carcinoma of the cervix with negative para-aortic lymph nodes: a Gynecologic Oncology Group and Southwest Oncology Group study. J Clin Oncol 1999;17(5):1339– 48.
Green JA, Kirwan JM, Tierney JF, Symonds P, Fresco L, Collingwood M, et al. Survival and recurrence after concomitant chemotherapy and radiotherapy for cancer of the uterine cervix: a systematic review and metaanalysis. Lancet 2001;358(9284):781–6.
Chemoradiotherapy for Cervical Cancer Meta-analysis Collaboration (CCCMAC). Reducing uncertainties about the effects of chemoradiotherapy for cervical cancer: individual patient data meta-analysis. Cochrane Database Syst Rev 2010;(1):CD008285.
Atahan IL, Onal C, Ozyar E, Yiliz F, Selek U, Kose F. Long-term outcome and prognostic factors in patients with cervical carcinoma: a retrospective study. Int J Gynecol Cancer 2007;17(4):833–42.
Özsaran Z, Yalman D, Dubova S, Akagündüz O, Aras A, Haydaroglu A. Lokal ileri evre serviks kanserinde radyoterapi sonuçları: Ege Üniversitesi deneyimi. Türk Jinekolojik Onkoloji Dergisi 2005;8;5–13.
Teh J, Yap SP, Tham I, Sethi VK, Chua EJ, Yeo R, et al. Concurrent chemoradiotherapy incorporating high-dose rate brachytherapy for locally advanced cervical carcinoma: survival outcomes, patterns of failure, and prognostic factors. Int J Gynecol Cancer 2010;20(3):428–33.
Parker K, Gallop-Evans E, Hanna L, Adams M. Five years’ experience treating locally advanced cervical cancer with concurrent chemoradiotherapy and high-doserate brachytherapy: results from a single institution. Int J Radiat Oncol Biol Phys 2009;74(1):140–6.
Lim A, Sia S. Outcomes of chemoradiotherapy in cervical cancer-the Western Australian experience. Int J Ra diat Oncol Biol Phys 2012;82(4):1431–8.
Coia L, Won M, Lanciano R, Marcial VA, Martz K, Hanks G. The Patterns of Care Outcome Study for cancer of the uterine cervix. Results of the Second National Practice Survey. Cancer 1990;66(12):2451–6.
Stehman FB, Bundy BN, DiSaia PJ, Keys HM, Larson JE, Fowler WC. Carcinoma of the cervix treated with radiation therapy. I. A multi-variate analysis of prognostic variables in the Gynecologic Oncology Group. Cancer 1991;67(11):2776–85.
Kodaira T, Fuwa N, Kamata M, Furutani K, Kuzuya K, Ogawa K, et al. Clinical assessment by MRI for patients with stage II cervical carcinoma treated by radiation alone in multicenter analysis: are all patients with stage II disease suitable candidates for chemoradiotherapy? Int J Radiat Oncol Biol Phys 2002;52(3):627–36.
Hsieh CH, Tsai SJ, Chiou WY, Lee MS, Lin HY, Hung SK. Better survival with three-dimensional conformal radiotherapy than with conventional radiotherapy for cervical cancer: a population-based study. ISRN Oncol 2013;2013:729819.
Goswami J, Patra NB, Sarkar B, Basu A, Pal S. Dosimetric comparison between conventional and conformal radiotherapy for carcinoma cervix: Are we treating the right volumes? South Asian J Cancer 2013;2(3):128–31.
Gulia A, Patel FD, Santam C, Bhavana R, Reena K, Sharma SC. Clinical significance of geographic miss when using conventional four field radiotherapy technique in treatment of locally advanced carcinoma cervix. Indian J Cancer 2016;53(1):80–5.
Pedersen D, Bentzen SM, Overgaard J. Early and late radiotherapeutic morbidity in 442 consecutive patients with locally advanced carcinoma of the uterine cervix. Int J Radiat Oncol Biol Phys 1994;29(5):941–52.
Bohr Mordhorst L, Karlsson L, Bärmark B, Sorbe B. Combined external and intracavitary irradiation in treatment of advanced cervical carcinomas: predictive factors for treatment outcome and early and late radiation reactions. Int J Gynecol Cancer 2014;24(7):1268– 75.
Chen CC, Lin JC, Jan JS, Ho SC, Wang L. Definitive intensity-modulated radiation therapy with concurrent chemotherapy for patients with locally advanced cervical cancer. Gynecol Oncol 2011;122(1):9–13.
Jadon R, Pembroke CA, Hanna CL, Palaniappan N, Evans M, Cleves AE, et al. A systematic review of organ motion and image-guided strategies in external beam radiotherapy for cervical cancer. Clin Oncol (R Coll Radiol) 2014;26(4):185–96.
Roeske JC, Bonta D, Mell LK, Lujan AE, Mundt AJ. A dosimetric analysis of acute gastrointestinal toxicity in women receiving intensity-modulated whole-pelvic radiation therapy. Radiother Oncol 2003;69(2):201–7.
Hasselle MD, Rose BS, Kochanski JD, Nath SK, Bafana R, Yashar CM, et al. Clinical outcomes of intensitymodulated pelvic radiation therapy for carcinoma of the cervix. Int J Radiat Oncol Biol Phys 2011;80(5):1436– 45.