Abstract
Background: Concurrent chemoradiotherapy is standard of care for the management of cervical cancer.
Objective: In this study we try to explore various prognostic factors for management of cervical cancer, stage II. The main objective was to analyze impact of various factors on disease response and toxicities.
Methods: This is a prospective analysis of 50 patients of stage II cervical cancer, treated with concurrent chemoradiotherapy. The most common regime used was Concurrent EBRT (External Beam Radiotherapy) + HDR (High Dose Rate) ICBT (Intra cavitary Brachytherapy) + weekly cisplatin (40 mg/m2). The most common dose fractionation regime was 7.5 Gy X 3 fractions or 6 Gy X 4 fractions. A total dose of 50 Gy was delivered by EBRT.
Results: Of the 50 patients, 14 patients (28%) were in stage IIa while 36 (72%) were in stage IIb. 41 (82%) achieved CR.
Conclusion: Out of the various factors analyzed NLR (Neutrophil-Leucocyte Ratio), pre-treatment Hb (Hemoglobin) value, number of weekly cisplatin cycle received were the only factors with significant impact on prognosis.
Keywords: Cervical cancer, HDR intracavitary brachytherapy, Prognostic factors, dose fractionation, acute toxicity, late toxicity.
References
- Maheshwari A, et al. Gynecological cancers: A summary of published Indian data. South Asian J Cancer. 2016 Jul-Sep; 5(3): 112–120.
- Burden of HPV related cancers. Human Papillomavirus and Related Diseases Report India. http://www.hpvcentre.net.
- GLOBOCON 2018. http://gco.iarc.fr/today/data/factsheets/populations/356-india-fact-sheets.pdf
- GLOBOCON 2018. http://gco.iarc.fr/today/data/factsheets/populations/900-world-fact-sheets.pdf
- Jain A, Ganesh B, Bobdey SC et al. Sociodemographic and clinical profile of cervical cancer patients visiting in a TCH in India. Indian Journal of Medical and Paediatric Oncology 2017 jul sep;38(3): 291 – 295.
- NCCN clinical practice guidelines in oncology: Cervical cancer [Internet] National Comprehensive Cancer Network; Version 2.2019. [cited November 30, 2018] Available from: http://www.nccn.org.
- Nag S, et al. The American Brachytherapy Society recommendations for High-dose-rate brachytherapy for carcinoma of the cervix. Int. J. Radiation Oncology Biol. Phys., Vol. 48, No. 1, pp. 201–211, 2000.
- American Brachytherapy Society consensus guidelines for locally advanced carcinoma of the cervix. Part I: General principles, https://www.americanbrachytherapy.org/ABS/document-server/?cfp=ABS/assets/file/public/guidelines/Guidelines_Carcinoma_Cervix_Part1.pdf
- Petereit DG, Sarkaria JN, et al. The adverse effect of treatment prolongation in cervical carcinoma. Int J Radiat Oncol Biol Phys 1995; 32:1301–1307.
- Saptarshi Ghosh, Pamidimukalabra-mhananda Rao High-Dose-Rate Orthogonal Intracavitary Brachytherapy with 9 Gy/Fraction in Locally Advanced Cervical Cancer: Is it Feasible? Journal of Obstetrics and Gynecology of India 2015;66(Suppl 1):1-7.
- National Cancer Institute. Concurrent chemoradiotherapy for cervical cancer. Clinical announcement. Washington, DC: National Cancer Institute,1999.
- Oken M, Creech R, Tormey D, et al. Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol. 1982; 5:649-655.
- RTOG FOUNDATION INC. RTOG/EORTC Late Radiation Morbidity Scoring Schema. 2018 Available from: https://www.rtog.org/researchassociates/adverseeventreporting/rtogeortclateradiationmorbidityscoringschema.aspx
Corresponding Author
Dr Rajesh Kumar
Senior Resident, Department of Radiation Oncology, Acharya Tulsi Regional Cancer Treatment and Research Institute, S.P. Medical Collage, Bikaner, Rajasthan, India, 334001