Concurrent chemoradiation therapy in cervical cancer: Prognostic factors, toxicity, and long-term survival in a center of reference for gynecologic cancer.

Abstract

e16539 Background: Concurrent chemoradiation therapy has been the standard treatment in locally advanced cervical cancer since 1999, and our institution is a centre of reference for treatment of this pathology. Methods: In a homogeneous series of 288 patients treated between 1996 and December 2011, survival data, prognostic factors and toxicity of the treatment have been analyzed. The treatment includes external beam radiotherapy, concurrent weekly chemotherapy and brachytherapy. Results: Median age of the patients is 54 years old, and the FIGO classification for disease stages shows 14.6% IB2, 47.1% IIB, 24.4% III, and 7.8% IVA. Squamous cell carcinoma (77.4%) and adenocarcinoma (16.8%) are the most common histologies. After a median follow-up of 4.4 years, the 5-year overall survival rate is 80.2%. Classified by diagnostic stage, they are 85% in IB2, 76% in IIB, 70% in III, and 68% in IVA. The main location for recurrence is cervix (11.8%), and the most common site for distant disease is lung (4.8%). For patients with disease progression, 24.4% have local and distant recurrence. After local recurrence, radical surgery with pelvic exenteration was practised in 6 cases, 5 of them are still alive. In the multivariate analysis, the prognostic factors for overall survival that have been identified with a statistical significance, are HPV and HIV infection, high stages of disease and older patients. Performance status ≥1 and brachytherapy have only a significant value in the univariate analysis. The acute toxicity grade ≥3 was observed in 19.4% of patients (14.1% haematological). The most frequent low grade toxicity was 46.3% haematological, 40% of bowel-related toxicity, 38.9% of nausea and vomiting, and 8.1% of renal dysfunction. Chronic toxicity grade ≥3 has been only seen in 1.2% of patients (renal dysfunction), and in the low grades, it is a 6% of bowel-related toxicity and 1.4% of mild renal dysfunction. Conclusions: This long follow-up series shows a good overall survival rate with chemoradiation therapy in locally advanced stages of cervical cancer, with a low rate of acute and, especially, chronic toxicity, indicating a good quality of life for these patients.