Lokal İleri Serviks Kanserinde Radyoterapi

Abstract

The aim of this study is to evaluate long-term results of definitive radiotherapy and concomittant chemotherapy in patients with locally advanced cervical cancer treated between 2000-2013 at Hacettepe University Faculty of Medicine Department of Radiation Oncology. The files of 474 patients were evaluated retrospectively for this purpose. The median age was 56 (24-88) and the median follow was 86 months (57.5-114.5 months). Eighty eight percent of the cases were with either Stage IIB or more advanced disease and the histology was SCC in 90% of cases. The survival and the prognostic factor analyses were made based on the 327 patients with pelvis confined disease whose last status data were accurately known. The 2, 5 and 10 years of Overall Survival (OS) rates were found to be as %68, %52 and %42 respectively. The corresponding Disease Free Survival (DFS), local recurrence free survival (LRFS), locoregional recurrence free survival (LRRFS) and distant metastases free survival (DMFS) rates were 73%, 66% and 64%; 94%, 92% and 91%; 92%, 89% and 86% and 81%, 76% and 75% respectively. The univariate analysis revealed clinical stage, concomittant chemotherapy use, Hb level at diagnosis (<10g/dl vs >10g/dl), BRT technique (3D vs 2D), ERT technique (3D vs 2D), lymphadenopathy in imaging and response to treatment (complete clinical response vs other) at the 3rd month as significant prognostic factors for OS. Similarly lymphadenopathy, stage of tthe diseas, hydronephrosis and the treatment response were found to be significant for DFS. Squamous cell histology and complete clinical response were the only prognostic factors for LRFS and the response to treatment for LRRFS. The unique factor significant for all survivals in the multivariate analysis was response to treatment. Age of the patient (<56y vs >56y), stage of the disease and lymphadenopathy were the other significant factors for OS and DFS. Late grade 2-4 GUS toxicity was observed in 6.4 % patients and grade 2-5 GIS toxicity in 8.3% of the patients. The only factor related to the late toxicity was maximum dose of rectum. There was no factor related to late GUS toxicity. A quality of life survey was applied to 85 patients and found that lymphedema related complaints were more intense in the first 5 years which was tended to decrease after 5 years Sexual activity and menopausal symptoms were found to be the most important issues in the quality of life. In addition role function and financial difficulties were observed significantly higher in married patients. Based on age, body perception, and cognitive function, symptoms such as sexual anxiety and fatigue showed significant changes. Body perception and fatigue were detected to be worse in case of comorbid diseases, nonetheless, in the absence of accompanying diseases, cognitive function, role function, and physical condition were observed to be better. Factors like age, concurrent chemotherapy, and neoadjuvant chemotherapy showed no significant impact on the quality of life. Educational status, the width of the RT field, RT technique and technique of BRT were found to affect the quality of life. In conclusion, the most important prognostic factor for all time points in patients with locally advanced cervical cancer was found to be the response to treatment in this retrospective analysis. The late toxicity rates were comparable to the literature. Comorbidity and the technique of the radiotherapy were the important factors affecting the QOL. Distant metastases were found to be the major cause of disease failure. Adjuvant chemotherapy after definitive chemoradiotherapy may decrease the distant metastases rate. Phase III trials should be performed for to seek the effcicacy of adjuvant chemotherapy in this regard.