Clinical outcomes of 3D conformal curative intent radiotherapy and chemoradiotherapy for inoperabl cervical cancer and acute-chronic side effects evaluation: Retrospective study

Purpose: Evaluation of treatment protocol outcomes for individual centres leads to treat patients with better treatment quality and improve the services. For this aim clinical outcomes of three dimentional conformal curative intent radiotherapy for inoperabl cervical cancer, prognostic factors, side effects and also side effects releated risk factors have been evaluated for patients treated in Ege University School of Medicine (EUTF) Department of Radiation Oncology. Material-methods: Between 2005 and 2015, 274 patients diagnosed as inoperabl cervix cancer and treated in EUTF Department of Radiation Oncology Clinic with curative intent conformal radiotherapy were retrospectively evaluated. Kaplan Meier test was used for survival analysis and prognostic factors releated with survival results was calculated univariate analysis with log-rank test, mutlivariate analysis cox regression test. Ki-square test was used for analyses of side effects related factors. Results were considered istatistically significant when p value was less then 0,05. Results: The median follow up time was 62.3 months (3-170) and most of the patients were staged as IIB (63.9%). Patients treated with chemoradiotherapy and brachytherapy were respectively 91% and 86%, for those whom brachytherapy applied, brachytherapy technique with image guided was 54 (19.7%) and 182 (66.7%) with convantional. For our serial, 10 years overall survival, disease free survival, locoregional control and distant metastasis free survival rate were found respectively 53%, 62%, 77% and 72%. Disease recurrence was seen in 90 (32%) patients and distant metastasis was the most frequent recurrence patern and paraaortic region was the most frequent distant metastasis site. Multivariate analyses results showed that treatment response at 3rd month (p<0.0001) and non-squamous carcinoma histology were related with all survival types as prognostic factors. Pelvic metastatic lymph node number ≥3 (p=0.042) and common iliac lymph node metastasis (p=0.025) were associated with distant metastasis. The presence of initial (before radiotherapy) hemoglobin level <10 mg/dl effected overall survival and disease free survival poorly. Overall survival was improved with concurrent chemotherapy (p<0.0001) and ≥4 cycles was associated with better overall survival outcome (p<0.0001). The most frequent acute grade ≥3 side effect was leucopenia (34%). Acute grade ≥3 hematological side effect related factors were found as initial Hb level <10 mg/dl and concurrent chemoradiotherapy. When late genitourinary (GUS) and gastrointestinal (GIS) side effects evaluated together, grade ≥3 side effect rate was 13%. Body mass index <18.5 was associated with late severe genitourinary side effect (p=0.001) and bracyhtherapy dose applied as 4x7 Gy was related with severe gastrointestinal late side effect (p=0.023). Brachytherapy tecnique could not found as severe chronic side effect related factor. Conclusion: Our serial survival results were similar when compared with literature and most frequent recurrence pattern was distant metastases that effected treatment outcomes. Paraaortic metastasis related factors were known as number of lmyph node metastasis and common iliac location, and ongoing randomised study results are going to lead profilactic paraaortic irradiation for high risk patients to prevent distant metastasis. Severe chronic side effect rates were correlated with other serials, whereas subgroup of patients treated with 3D-BRT were found with increased severe late side effect when compared with other studies. This fact should be evaluated with another study which analyses dosimetric data and severe late side effects correlation.