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1148 Choosing the right time: radiotherapy commencement for locally advanced cervical cancer
  1. Jairo Rubio-Cordero,
  2. Guillermo Moreno-Flores,
  3. Erick Raveles-Ricardez,
  4. Rebeca Ramírez,
  5. Abraham Osuna,
  6. Katia Gutierrez-Quiroz,
  7. Lenny Gallardo-Alvarado and
  8. David Cantu De Leon
  1. Insitituto Nacional de Cancerologia, Cdmx, Mexico


Introduction/Background Cervical cancer is a public health problem worldwide. Concurrent chemoradiotherapy is the standard of treatment in locally advanced cervical cancer (LAAC), however, in low resource settings a shortage in radiation therapy (RT) units causes delays in starting treatments. The aim of our study is to determine the time to progression of LACC by imaging studies prior to the start of RT.

Methodology Retrospective analysis of 215 patients with LACC from a national reference center in Mexico. FIGO 2018 staging was established by clinical evaluation and CT scan. PET/CT was performed in cases of suspected more advanced disease or when RT was delayed. Descriptive and inferential statistics, Cohen Kappa index and ROC curve were performed.

Results Median age at diagnosis was 45 years. Most common FIGO staging by clinic was IIB (46.5%), by CT IIIC1 (43.3%) and IIIC1 (40%) by PET/CT. FIGO stage IV was established in 7.4% by CT and 20.4% by PET/CT. Cutoff time to progression was 30 days by ROC (AUC 0.77, p = 3.9x10–9) with sensitivity of 70.8% and specificity of 72.7%. Strength of agreement between CT and PET/CT within 30 days was substantial (k = 0.677, p = 0.0001) meanwhile after 30 days the agreement was limited (k = 0.313, p = 0.0001) and after that timepoint, 21.4% of cases had disease progression (Xi2 p = 0.0001).

Conclusion The initiation of radiotherapy (RT) in locally advanced cervical cancer (LACC) lacks a standardized optimal timeframe. Our findings indicate that computed tomography (CT) can serve as the primary staging study for LACC within the initial 30 days. Beyond this timeframe, suspicion of disease progression is warranted if RT has not commenced, and additional imaging studies should be considered. It is crucial to implement strategies aimed at averting disease upstaging and enhancing the timely initiation of RT.

Disclosures Nothing to disclose.

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