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Abstract
Introduction/Background*To review overall survival (OS) and disease-free survival (DFS) for cervical cancer patients, unable to receive high dose rate brachytherapy (HDR BT), treated with external beam radiotherapy (EBRT) phase 2 boost
Methodology Data was retrospectively reviewed for patients treated with EBRT phase 2 boost for cervical cancer between 2011 and 2018. Staging, outcomes, recurrence rate and rationale for omitting HDR BT was recorded. The EBRT dose was 45Gy in 25 fractions to the pelvis +/- para-aortic area, followed by a phase 2 treatment of 20Gy in 10 fractions to residual primary disease. OS and DFS were calculated as a whole and for subgroups based on stage. The Kaplan-Meier method was used with log rank value to assess statistical significance, with two-tailed significance testing and with a p-value <0.05 deemed significant. All analysis was done using IBM SPSS statistical software version 24.
Result(s)*A total of 110 patients received a phase 2 boost over this 8 year period. The median age was 61 years (min 18 to max 87). The median radiotherapy dose was 64Gy (min 14Gy– max65Gy). Reasons for phase 2 include co morbidity (42%), technical limitations (30%), patient choice (11%) and poor compliance (17%).
The stage (FIGO 2009) distribution was: stage 1 (N=3), stage II (N=56), stage III (N=28) and stage IVA (N=23). The five-year DFS and OS for the entire cohort was 46% and 27% respectively. Analysing by stage the 5 year DFS for stage I was 33%, stage II was 46%, stage III was 50% and stage IVA was 43%. The 5 year OS for stage I was 33%, stage II was 34%, stage III was 25% and stage IVA was 13%. 5-year OS for reasons precluding HDR BT were technical limitations (24%), Co-morbidity (28%), patient choice (50%) and poor compliance (16%).
Conclusion*This data demonstrates that OS and DFS for patients receiving EBRT phase 2 boost are inferior to those who receive HDR BT, irrespective of stage. It highlights the integral role of HDR BT in the treatment of cervical cancer and patients should be aware that omission can compromise outcome.