Predictors of survival end points in patients with cancer of the cervix on long-term follow-up: inferences and implications from an audit of patients treated with a specific radiotherapy protocol
Received 2 March 2004; received in revised form 27 May 2004; accepted 2 June 2004.
Abstract
Aims
An audit of patients with cancer of the cervix treated with a specified protocol of external beam radiotherapy (EXRT) followed by intracavitary brachytherapy (ICBT) was carried out to determine the prognosticators for major survival end points.
Materials and methods
Patients treated between 1991 and 2003 with a uniform protocol of EXRT (50Gy/25 fractions/5 weeks) followed by high-dose-rate ICBT (18Gy/3 fractions/3 weeks) were selected from the database. Various clinical and treatment parameters were evaluated for extent of locoregional response at completion of EXRT, namely absence or presence of gross residual tumour (AGRT and PGRT, respectively) and survival end points. These included locoregional disease-free survival (LDFS), disease-free survival (DFS) and overall survival (OS).
Results
Of the 157 evaluable patients, 145 (92%) belonged to FIGO stages II and III. Eighty-three (53%) at completion of EXRT had AGRT, which was influenced by age and gross tumour features. The estimated 10-year LDFS, DFS and OS were 38.6%, 33.1% and 38.5%, respectively. Factors significant on univariate analysis for these survival end points were EXRT duration, ICBT time, overall treatment time (OTT) and EXRT response. On multivariate analysis, AGRT to EXRT, an OTT of ≤67 days, and patients older than 50 years were the significant favourable determinants for all the above survival end points.
Conclusion
The audit highlights that younger people, especially those with bulky tumours that determine response to EXRT, are poor prognosticators for survival end points. They could perhaps benefit from treatment intensification regimens using chemoradiotherapy, provided that OTT is not unduly prolonged.
*Department of Radiotherapy, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
†Department of Biostatistics, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
Author for correspondence: Dr Niloy Ranjan Datta, MD, DNB, Additional Professor and Head, Department of Radiotherapy, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Rae Barelli Road, Lucknow 226014, UP, India. Tel: +91-522-2668004 to 8/2668700, ext 2449; Fax: +91-522-2668017/2668973.
ABSTRACT