Evaluation of the overall survival rates in locally advanced cervix cancer patients treated with radiotherapy alone and chemoradiation: A Brazilian experience.

Abstract

e15509 Background: Locally advanced cervical cancer is a major worldwide health problem. The treatment might include radiotherapy and few trials evaluate the timing of pelvic external irradiation (RT) and high dose rate brachytherapy (HDR) in local control and survival rates of these patients as well as the addition of chemotherapy. The objective were to evaluate the overall survival rates in locally advanced cervix cancer patients and determine the clinical and treatment prognostic factors for local control and overall survival rates. Methods: A retrospective cohort study was carried out with 261 patients stage IIIB, 164 patients received 54 Gy RT to the pelvis and 30 Gy HDR without chemotherapy and 97 patients received 54 Gy RT to the pelvis and 30 Gy HDR with weekly cisplatin 40mg/m2 IV (CDDP) from August 1998 to June 2004 in Hospital Haroldo Juacaba, a Brazilian northeastern hospital. The mean follow-up time was 50 months (2-185 months) and the Kaplan-Meier method was used to calculate survival curves. The Cox regression was used to evaluate multivariate analysis and p values =<0.05 was considered significant. Results: Local control and 5-year survival rates were 39.6% and 38.4% for exclusively radiation and 50.5% and 47.4% for chemoradiation (p = 0.19 and p = 0.36, respectively). The mean treatment time was 61 days. Both local control and overall survival rates were affected by age, parametrial involvement and the timing of brachytherapy (p<0.05). The overall treatment time did not influence survival or local control rates (p>0.05). But less than six cycles of chemotherapy improved local control rates better than six or more cycles (55.1% versus 44.9% p = 0.02). Conclusions: The study is a nonsuperiority one where the addition of weekly chemotherapy with six cycles of CDDP 40mg/m2 during the irradiation did not improve overall survival rates. Further prospective studies would be useful to evaluate the benefit of adding weekly chemotherapy to the standard radiotherapy treatment as well as the financial impact of the adoption of this international guideline in patients with advanced lesions from developing countries.