Impact of prolongation of overall treatment time and timing of brachytherapy on outcome of radiation therapy in carcinoma of uterine cervix

Abstract

15032 Background: Studies have described decreased pelvic control & survival rates in invasive ca cervix when overall time in definitive RT is prolonged. We evaluated impact of timing of brachytherapy on outcome. Methods: Retrospective analysis of 338 patients of ca cervix treated with radical RT from Jan 2002 to Dec 2002 at Mahavir Cancer Sansthan Patna. The median age was 50 yrs (23–80 yrs). 73% patients were postmenopausal. Histopathology was Squamous Cell in 97% patients. Most common presenting complaints were bleeding P/V (92%) & discharge P/V (82%); with stage I (3%), II (35%), III (43%), IV (5%), unknown stage in 14% cases. Results: Records of 338 patients (Stage IB to III) treated with definitive irradiation (combination of EBRT & ICRT) were reviewed with reference to loco regional control, distant failure and its correlation with patient and tumor variables including OTT. Out of 302 patients who received complete RT, 24 received 60 Gy in 30 fractions as they were found to be unsuitable or were unwilling for ICRT. The rest received a dose of 50 Gy/25 Fr to 50.4 Gy/28 Fr over a median duration of 37 days. 30 patients received concomitant chemo radiation (cisplatin 40 mg/m2/4 cycles). 276 patients received ICRT (dose 21 Gy in 3 Fractions with a median gap of 43 days (range 5–111) after completion of ERT. The median OTT for completion of ERT & ICRT was 75 days (range 54–177). At an average follow up of 18- 24 months residual disease was seen in 2 cases (0.6%), local recurrence in 14 cases (4%) & distant failure in 14 cases (4%). Post RT complications were seen in 4.7% cases and included small bowel obstruction in 6 cases, VVF in 4 & RVF in 6 cases. Significant correlation was seen between OTT and rate of loco regional recurrences. All local recurrences were seen when OTT was more than 75 days. No significant correlation could be drawn between age, Hemoglobin, tumor histology, & bulky vs. non bulky tumor on loco regional and distant failure. Conclusions: Longer radiotherapy completion time was found to be associated with diminished survival outcomes for patients treated radically for carcinoma cervix. The significance of this observed association requires further investigation & correction to keep OTT as short as possible. No significant financial relationships to disclose.