Evaluation of Clinical Parameters, Survival Outcomes, and Toxicities in Patients of Cervical Cancer with Lower One Third Vaginal Involvement

Abstract

Objective of this study was to evaluate the clinical features, brachytherapy treatment parameters and clinical outcome of cervical cancer patients presenting with lower third vaginal involvement. Another objective of this study was to test our hypothesis that survival outcome of patients of FIGO stage IIIA is better than stage IIIB with lower one third vaginal involvement The patients with histologically proven invasive cervical cancer with clinical FIGO stage IIIA and IIIB with lower one third vaginal involvement, treated with radio(chemo)therapy between 2010 and 2016 at our Institution were analyzed. Patient characteristics, clinical staging, tumor characteristics, treatment parameters (radiation, chemotherapy etc.), follow-up details including relapse patterns and alive status were compiled from the electronic medical records and analyzed. One hundred and thirty-six cervical cancer patients with lower third vaginal involvement were retrospectively analyzed. Out of 136 patients, 51 patients (37%) were FIGO stage IIIA, 74 patients (55%) stage IIIB and 11 (8%) patients were FIGO stage IVA at diagnosis. One hundred and one (75%) patients received CTRT or NACT f/b CTRT while 34 (25%) patients received RT alone (chemotherapy was deferred due to elderly age or poor renal function). Post external beam radiotherapy vaginal disease was present in 29 patients.19 patients underwent brachytherapy in the form of tandem -cylinder while 94 patients received tandem - ovoid intracavitary brachytherapy while remaining received advanced interstitial BT (Vienna / MUPIT based BT). At a median follow up of 30 months, 18 patients (14%) developed loco regional recurrences, 33 patients (23%) developed distant and 2 patients developed loco-regional and distant relapses. Forty-five patients had died with 40 patients (30%) due to disease while 5 patients due to other causes. In patients with loco-regional recurrence, 6 had stage IIIA (total: 51 patients) while 10 patients were IIIB (total: 74 patients) and remaining 4 patients had Stage IVA Also, out of these 20 patients, only 6 patients had post EBRT lower third vaginal disease while remaining 14 patients had no vaginal disease at BT. These 6 patients had tandem-cylinder and others had tandem-ovoid intracavitary brachytherapy. The 3 years disease free and overall survival for the whole cohort was 62% and 70% respectively. Treatment modality (CTRT Vs RT; p = 0.0001) had significant impact on DFS while age (< 70 Vs > 70 years; p = 0.021), FIGO Stage (IIIA Vs IIIB; p=0.05), treatment modality (CTRT Vs RT; p < 0.0001) and residual disease at BT (p=0.0001) had significant impact on overall survival. Cervical cancer presentation with lower third vaginal involvement (FIGO IIIA) is rare. The outcome of patients with FIGO IIIA is better than IIIB with lower vaginal involvement. Elderly patients, patients not receiving concomitant chemotherapy and presence of residual disease at BT is associated with poor outcome.