Treatment Results and Prognostic Factors of FIGO Stage III and IVA Cervical Cancer Treated with Concurrent Chemoradiotherapy

Abstract

Purpose: To investigate the overall survival, local control and distant control of patients with locally advanced squamous cell carcinoma of the cervix treated with concurrent chemoradiotherapy (CCRT). We analyze the prognostic factors affecting their outcomes.Materials and Methods: We conducted a retrospective analysis of 106 patients with FIGO stage III-IVa carcinoma of the cervix treated with CCRT between January 1999 and December 2008 in our institution. Ninety-three patients with squamous cell carcinoma (87.7%). Survival estimations were analyzed using the Kaplan-Meier method. Univariate analysis was performed using the log-rank test. Multivariate analysis was performed using the Cox proportional hazards model.Results: The median age at diagnosis was 55 years (range: 34-86 years). The median follow-up period was 57.05 months (range: 4.57-137.3 months) respectively. The 5-year overall survival (OS) rate was 63.4%, and 5-year local control (LC) and distant control (DC) rates of 61.3% and 57.0%, respectively. Thirty-four of 93 patients (36.6%) were diagnosed with recurrence or distant metastasis at the follow-up time. Twenty-five patients (26.8%) had distant failure, of which 24 had only distant metastasis, one patient had both distant and loco-regional recurrence, and the remaining 9 patients recurred locoregionally.ECOG performance status, tumor size, pelvic lymphadenopathy, pre-treatment hemoglobin and elevated serum SCC level after CCRT were significantly correlated with 5-year OS, LC and DC by univariate analysis. The ECOG performance status and elevated serum SCC after CCRT are significant prognostic factors for 5-year OS and LC rate. The performance status, tumor size (＞4 cm) and elevated serum SCC level after CCRT were significant for 5-year DC rate by multivariate analysis.Conclusions: The patient with poor ECOG performance status, bulky tumor (＞4cm) and elevated serum SCC after CCRT had worse outcome. More aggressive treatment may be considered for these patients.[Therapeut Radiol Oncol 2011; 18(4): 275-286]