Prognostic significance of pretherapeutic and therapeutic factors in patients with advanced cancer of the uterine cervix treated with radical radiotherapy alone

Clinical relevance of hemoglobin level in cervical cancer patients administered definitive radiotherapy

The prognostic impact of pretreatment hemoglobin (Hb) level and its changes during definitive radiotherapy was evaluated by univariate and multivariate analysis in the group of 453 FIGO IB-IIIB cervical cancer patients. Pretreatment anemia (Hb < 12 g/dl) was present in 148 patients (33%), and anemia at the end of irradiation in 48%; in 64% Hb level declined during therapy. Median overall survival in patients with initial Hb >or=12 g/dl was 66 months compared to 22 months in those with lower baseline Hb levels (p = 0.0001). This difference was mainly due to increased risk of distant spread in anemic patients (40% compared to 25% in subjects with pretreatment Hb >or=12 g/dl; p = 0.001). Baseline Hb >or=12 g/dl was also associated with longer disease-free survival and improved local control. Declining Hb level during radiotherapy predicted for impaired 5-year disease-free survival and local control probability. In multivariate analysis, low pretreatment Hb level remained associated with worse overall and disease-free survival, whereas adverse impact of declining Hb level on outcome was not observed. With regard to other clinical factors, stage and tumor extension (uni- or bilateral parametrium involvement for Stage III) were the only independent determinants of prognosis.

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

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 (50 Gy/25 fractions/5 weeks) followed by high-dose-rate ICBT (18 Gy/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 < or = 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.

Ethnic differences in survival among Pacific Island patients diagnosed with cervical cancer

BACKGROUND

It was the purpose of this study to investigate whether Pacific Island (PI) ethnicity, Micronesian and Polynesian, is an independent prognostic factor in the survival of cervical cancer in a health care system with minimal racial bias and few barriers to access to care.

METHODS

Records from 1988 to 1999 were reviewed for the U.S. Military Health Care System. The medical records of women with the diagnosis of invasive cervical cancer were abstracted and clinical data recorded. A cohort analysis based on Pacific Island ethnicity was also performed on all patients treated at Tripler Army Medical Center (TAMC) during this time period. Significant differences in distribution of clinical factors were determined by Wilcoxon rank-sum test and survival analyses were performed using Kaplan-Meier actuarial statistics.

RESULTS

A total of 153 patients were identified who were treated at TAMC; 74 were of PI ethnicity. An additional 1400 patients were identified throughout the military health care system during this time. Forty-eight percent of non-PI TAMC patients were Caucasian, 14% Filipino, and 13% Korean. The mean age of PI was 45 versus 40 years for their non-PI counterparts. There was no difference in the distribution of the grade of tumors among cohorts analyzed. Seventy-five percent of non-PI patients presented at an early stage while 74% of PI women presented at an advanced stage. Twenty-three percent of PI patients had positive lymph nodes, versus 7% of non-PI patients. There was no difference in the radiation dosages among patients treated with primary radiation therapy. PI patients had a significantly decreased 5-year survival, 32% versus 71%, compared to their cervical cancer patient counterparts, P < 0.001. Multivariate analysis revealed PI ethnicity to be a significant independent predictor of decreased survival, P < 0.001.

CONCLUSION

PI women diagnosed with cervical cancer tend to present at an advanced age and stage with metastatic disease. They have a decreased survival that remains present after adjusting for age, stage, and grade. The poor prognosis is likely due to lack of uniform screening among this population; however, molecular etiologies and human papillomavirus could also contribute to decreased survival.