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Abstract
Introduction/Background The integral results of clinical examination and magnetic resonance imaging (MRI) in patients with locally advanced cervical cancer (LACC) may provide prognostic information that cannot readily be placed in current staging systems such as proximal versus distal parametrial invasion, unilateral versus bilateral involvement or organ infiltration on MRI. The aim was to investigate the performance of a simple but wide-ranging tumour score for reporting and prognostication.
Methodology 400 consecutive patients with LACC treated 2005–2018 with external beam radiotherapy ± concomitant cisplatin and image guided adaptive brachytherapy were analysed. The diagnostic work-up included clinical examination, positron emission tomography-computed tomography (PET/CT) and MRI. International Federation of Gynecology and Obstetrics (FIGO) 2009 stage distribution was IB-IIA 9%, IIB 61% and III-IV 30%. The degree of involvement of 8 anatomical locations (cervix, left parametrium, right parametrium, vagina, bladder, ureters, rectum and uterine corpus) was scored according to a ranked ordinal scale with 0–3 points. The total sum of points constituted the T-score.
Results The median T-score was 6 (range 0–20). The likelihood of receiving full course concomitant chemotherapy decreased significantly with T-score (figure 1), with only about 50% of the patients being able to receive ≥5 courses when T-score = 8. Prediction of the use of interstitial needles for brachytherapy increased sharply with 45% and 90% of patients with T-score of 6 and 12 requiring needles, respectively. Based on the frequency distribution of the T-score, 4 equally sized risk groups were formed: 0–4, 5–6, 7–9 and >9 (figure 2). The T-score was highly significant in both univariate and multivariate analysis and outperformed FIGO stage for both survival and local control.
Logit curves for concomitant chemotherapy (left) and interstitial brachytherapy (right)]
Overall survival according to T-score for all patients (left) and for stage IIB (right)
Conclusion The T-score may predict the ability of patients to undergo concomitant chemotherapy and the need for interstitial brachytherapy. In addition, the T-score is a powerful full prognostic factor for survival and local control.
Disclosure Nothing to disclose.