Survival outcomes in carcinoma cervix with contemporary radiation therapy: an insight

Himanshu Srivastava; Tejas Kalyanpur; Harnoor Singh Pruthi; Preety Negi

doi:10.18203/2320-1770.ijrcog20242497

Authors

Himanshu Srivastava Department of Radiation Oncology, Capitol Hospital, Jalandhar, Punjab, India
Tejas Kalyanpur Department of Radiology, Capitol Hospital, Jalandhar, Punjab, India
Harnoor Singh Pruthi Department of Cardiology, Capitol Hospital, Jalandhar, Punjab, India
Preety Negi Department of Radiation Oncology, Capitol Hospital, Jalandhar, Punjab, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20242497

Keywords:

Cervix uteri, Disease-free survival, Prognosis, Standard of care, Survival analysis

Abstract

Background: Concurrent chemoradiation therapy (CCRT) followed by brachytherapy is the standard of care treatment for locally advanced cervical cancer (stage IB3-IVA disease). The present study aimed to evaluate the success achieved by CCRT followed by computed tomography (CT)-based brachytherapy in patients with locally advanced carcinoma cervix in a tertiary care center.

Methods: This was a prospectively conducted retrospective observational study of patients with cervical carcinoma, treated at Capitol Hospital, Jalandhar, Punjab, from January 2018 to December 2021. Data were captured from the electronic medical records of the hospital. Overall survival (OS) and disease-free survival (DFS) were calculated using the Kaplan-Meier curve. The survival analysis was assessed by the patient’s age, tumor stage, histology, and overall treatment duration.

Results: This study included 129 patients treated with CRT followed by CT-based brachytherapy. The median follow-up was 30 months (range 8-67 months). The 2-year OS and DFS were 83.5% and 80.2%, respectively. On univariate analysis, the factors associated with better survival were histology, and treatment duration, although not statistically significant.

Conclusions: Our treatment results with definitive CCRT followed by CT-based brachytherapy for locally advanced cervical carcinoma are comparable to the published literature. The prognostic factors such as tumor histology and treatment duration (<65 days) influenced patient survival, with squamous cell carcinoma, and completion of the treatment within 65 days resulted in better survival rates.

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References

Singh D, Vignat J, Lorenzoni V, Eslahi M, Ginsburg O, Lauby-Secretan B, et al. Global estimates of incidence and mortality of cervical cancer in 2020: a baseline analysis of the WHO global cervical cancer elimination initiative. Lancet. 2023;11:E197-206.

Marima R, Mathabe K, Setlai B, Batra J, Sartor O, Mehrotra R, et al. Cervical cancer in low and middle-income countries. Oncol Lett. 2020;20(3):2058-74.

Mehrotra R, Yadav K. Cervical cancer: formulation and implementation of Government of India Guidelines for screening and management. Indian J Gynecol Oncol. 2022;20(1):4.

Keys HM, Bundy BN, Stehman FB, Muderspach LI, Chafe WE, Suggs 3rd CL, 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.

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;340:1144-53.

Whitney CW, Sause W, Bundy BN, Malfetano JH, Hannigan EV, Fowler WC, 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.

Morris M, Eifel PJ, Grigsby PW, Levenback C, Stevens RE, Rotman M, 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.

Peters WA, Liu PY, Barrett RJ, 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.

Green HM, Counsell N, Ward A, McCormack M. Neoadjuvant chemotherapy in locally advanced cervical carcinoma- a role in patients with para-aortic lymph node involvement? A 10-year institutional experience. Clin Oncol. 2022;34:e281-90.

Han K, Milosevic M, Fyles A, Pintilie M, Viswanathan AN. Trends in the utilization of brachytherapy in cervical cancer in the United States. Int J Radiat Oncol Biol Phys. 2013;87(1):111-9.

Gill BS, Lin JF, Krivak TC, Sukumvanich P, Laskey RA, Ross MS, et al. National Cancer Data Base analysis of radiation therapy consolidation modality for cervical cancer: the impact of new technological advancements. Int J Radiat Oncol Biol Phys. 2014;90(5):1083-90.

Ahmed HZ, Vijayakumar S, Duggar WN, Allbright R. MRI-directed brachytherapy for cancer of the uterine cervix: a case report, review, and perspective on the importance of widespread use of this technological advance in the United States. Cureus. 2021;13(6):e15495.

Toita T, Ohno T, Kaneyasu Y, Kato T, Uno T, Hatano K, et al. A consensus-based guideline defining clinical target volume for primary disease in external beam radiotherapy for intact uterine cervical cancer. Japan J Clin Oncol. 2011;41(9):1119-26.

Taylor A, Rockall AG, Reznek RH, Powell ME. Mapping pelvic lymph nodes: guidelines for delineation in intensity-modulated radiotherapy. Int J Radiat Oncol Biol Phys. 2005;63(5):1604-12.

Marks LB, Yorke ED, Jackson A, Ten Haken RK, Constine LS, Eisbruch A, et al. Use of normal tissue complication probability models in the clinic. Int J Radiat Oncol Biol Phys. 2010;76(3):S10-9.

Wang M, Huang K, Wong MCS, Huang J, Jin Y, Zheng ZJ. Global cervical cancer incidence by histological subtype and implications for screening methods. J Epidemiol Global Health. 2024;14(1):94-101.

Sung H, Ferlay J, Siegel RL. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71(3):209-49.

Singh JK, Chauhan R. Management of locally advanced cancer cervix- an Indian perspective. Rev Recent Clin Trials. 2015;10(4):298-301.

Supriya C, Gupta M, Ashwathy M, Mahantshetty U, Engineer R, Gupta L, et al. Locally advanced cervical cancer: a study of 5-year outcomes. Indian J Cancer. 2018;55(1):45-9.

Kaverappa VB, Prakash B, Kulkarni P, Renuka M. Sociodemographic profile of patients with cervical cancer in a tertiary-care cancer hospital in Mysuru, Karnataka. Int J Med Sci Public Health. 2015;4(9):1187-90.

Mayadev JS, Ke G, Mahantshetty U, Pereira D, Tarnawski R, Toita T. Global challenges of radiotherapy for treatment of locally advanced cervical cancer. Int J Gynec Oncol. 2022;32(3):436-45.

Mittal P, Chopra S, Pant S, Mahantshetty U, Engineer R, Ghosh J, et al. Standard chemoradiation and conventional brachytherapy for locally advanced cervical cancer: is it still applicable in the era of magnetic resonance-based brachytherapy? J Clin Oncol. 2018;4:1-9.

Jeevarajan SUD, Harikrishnan PSR, Balamurugan TD, Arunachalam AK. Survival rate in cancer cervix patients in a regional cancer center of South India: a retrospective analysis. J Obstet Gynecol India. 2023;73(5):414-20.

Quinn BA, Deng X, Colton A, Bandyopadhyay D, Carter J, Fields EC. Increasing age predicts poor cervical cancer prognosis with subsequent effects on treatment and overall survival. Brachyther. 2019;18(1):29-37.

Yokoi E, Mabuchi S, Takahashi R, Matsumoto Y, Kuroda H, Kozasa K, et al. Impact of histological subtype on survival in patients with locally advanced cervical cancer that were treated with definitive radiotherapy: adenocarcinoma/adenosquamous carcinoma versus squamous cell carcinoma. J Gynecol Oncol. 2017;28(2):e19.

Xiong Y, Liu J, Chen S, Zhou Q, Xu W, Tang C, et al. Combination of external beam radiotherapy and californium-252 neutron intracavitary brachytherapy is more effective in control of cervical squamous cell carcinoma than that of cervical adenocarcinoma. Med Oncol. 2015;32(9):231.

Hu K, Wang W, Liu X, Meng Q, Zhang F. Comparison of treatment outcomes between squamous cell carcinoma and adenocarcinoma of cervix after definitive radiotherapy or concurrent chemoradiotherapy. Radiat Oncol. 2018;13(1):249.

Chen SW, Liang JA, Yang SN, Ko HL, Lin FJ. The adverse effect of treatment prolongation in cervical cancer by high-dose-rate intracavitary brachytherapy. Radiother Oncol. 2003;67(1):69-76.

Tanderup K, Fokdal LU, Sturdza A, Haie-Meder C, Mazeron R, Limbergen EV, et al. Effect of tumor dose, volume, and overall treatment time on local control after radiochemotherapy including MRI-guided brachytherapy of locally advanced cervical cancer. Radiother Oncol. 2016;120(3):441-6.

Hong JC, Foote J, Broadwater G, Sosa J, Gaillard S, Havrilesky L, et al. Data-derived treatment duration goal of cervical cancer: Should 8 weeks remain the target in the era of concurrent chemoradiation? JCO Clin Cancer Inform. 2017;1:1-15.

Lin SM, Hong JH, Ku HY, Liu TW, Chang TC. The prognostic impact of overall treatment time on disease outcomes of uterine cervical cancer patients: a nationwide cohort study of Taiwan. Int J Radiat Oncol Biol Phys. 2016;96(2):E301.

Mazeron R, Castelnau-Marchand P, Dumas I, Campo ER, Kom LK, Martinetti F, et al. Impact of treatment time and dose escalation on local control in locally advanced cervical cancer treated by chemoradiation and image-guided pulsed-dose rate adaptive brachytherapy. Radiother Oncol. 2015;114(2):257-63.

Amneus MW, Park S, Delic L, Chung P, Botnick M, Cass I, et al. Survival impact of prolonged treatment duration in primary chemoradiation for cervical cancer. Obstet Gynecol Int J. 2015;3(3):314-21.