Prognostic factors for recurrence in elderly patients with cervical carcinoma

Abstract

16564 Background: Uterine cervix carcinoma is the most commonly diagnosed, fatal cancer in women in developing countries. World wide the age distribution of new cases is bimodal with peaks at ages 30–39 and at ages 60–69 years. Age has been reported as an adverse prognostic factor however other issues related to co-morbidity conditions and treatment might influence the impact of age as an independent prognostic factor. The aim of this study was to describe the characteristics and outcomes of elderly patients with invasive cervical cancer treated in our institution Methods: Records of patients age 60 and older with invasive cervical cancer treated with radiation with or without concomitant chemotherapy between 2004 to 2006 were reviewed. Recurrence free survival and predictors of outcomes were analyzed using Kaplan-Meier method and Cox regression analysis Results: 85 patients with invasive cervical carcinoma were identified (median age = 68, median age at first intercourse = 18, median number of sexual partners = 2, median number of pregnancy = 7). 55% had co-morbidity, 17% smokers, 83% had inadequate cytologic screening, 88% squamous cell carcinoma 12% adenocarcinoma. Stage distribution: IA2-IB2- 35%, IIA, B- 34.%, IIIA, B-28% IVA 3%. Treatment modality: Radiotherapy alone 27 pts (32%), chemoradiation 48 pts (57%), surgery and adjuvant radiation therapy 8pts (9%), neoadjuvant chemoradiation followed by surgery 2 pts (2%). Median dose of irradiation was 75 Gy. 65 pts (76%) underwent low dose rate brachytherapy. Cisplatin was used as radiosensitizer in 45 pts (82%) and Gemcitabine in 6 pts (12%). After a median follow up of 17 months (range 3–44 months), 20 pts (23%) relapsed. Factor associated with recurrence free survival in the univariate analysis were smoking (p=0.015), radiation therapy dose (p=0.010), stage I-II vs III-IV (p=0.024) and not receiving brachytherapy (p=0.021). In multivariable analysis only smoking was an independent prognostic factor (HR 4.1 CI 95% 1.4–11.6 p=0.007). Conclusions: This study suggest a role of smoking as an adverse prognostic factor for early recurrence in cervical carcinoma, further studies evaluating this factor in prospective setting are recommended. Agressive policies should be implemented to improve the screening of cervix cancer in our country. No significant financial relationships to disclose.