Clinical outcomes and patterns of severe late toxicity in the era of chemo-radiation for cervical cancer

Abstract

We present a comprehensive analysis of both therapy-induced severe late toxicity and outcome in a cohort of cervical cancer patients following radiation who were treated according to current guidelines and discuss the methodologic problems of systematically reporting these cases. We introduce a revised concept of reporting treatment failure. The records of 128 cervical cancer patients who received radiation from 2003 to 2008 were reviewed. Thirteen patients (10.2%) developed severe late toxicity. The combination of heavy smoking and cardiovascular diseases was found to be a significant contributing factor (HR 6.55, 95% CI 0.99-43.49, p = 0.048). Thirty patients (23.4%) experienced treatment failure. Of these, 12 (9.4%) were defined to have persistent disease, and 18 (14.0%) developed recurrent disease. Patients with recurrent disease had significantly better survival time (p < 0.001). Compared with the persistence subgroup, they had significantly more often multiple sites of relapse (66.7 vs. 8.3%, p = 0.002) and the sites were more often diagnosed outside the pelvis (70.7 vs. 7.7%, p < 0.001). Early disease stages (OR 4.46, 95% CI 1.87-10.63, p < 0.001) and severe late toxicity (p = 0.037) were found to be significant factors for an improved disease-free survival. A comprehensive depiction of both late therapy-related toxicity and treatment failure requires precise clinical descriptions and analyses of the clinical courses. Our new concept to differentiate treatment failure following radiotherapy in cervical cancer into persistent and recurrent disease permits a clear differentiation between distinct subgroups of patients with regard to prognosis and clinical presentation and will lead to a more precise description of these cases in the future.