Tumour and treatment factors influencing the outcome of chemo-radiation in stage IIB cervical cancer: a single institution experience

  • Mtabeni George Jemu Groote Schuur Hospital and University of Cape Town
  • Leon Van Wijk Groote Schuur Hospital and University of Cape Town
  • Michelle Parker Groote Schuur Hospital and University of Cape Town
  • Glenn Jones The University of the West Indies
Keywords: average weekly haemoglobin, cervical cancer, concurrent chemo-radiation, non-squamous histology, number of cisplatin cycles, overall treatment time, stage IIB

Abstract

Objective: This study examined the effects of treatment and tumour factors on the overall survival of patients completing chemo-radiation for stage IIB cervical cancer, to identify modifiable factors that might improve outcome. Materials and methods: A retrospective audit was undertaken of 228 patients with stage IIB cervical cancer treated between 1995 and 2010, who received chemo-radiation with at least 45 Gy external beam radiation, two to four brachytherapy sessions, and one to six weekly cycles of concurrent cisplatin (40 mg/m², capped at 60 mg/week). Results: Mean total dose to Point A from external beam radiation and brachytherapy was 83 Gy (range 61–96 – expressed as the linear quadratic equivalent dose to 2 Gy/fraction). Mean overall treatment time was 45 days. The average weekly haemoglobin (AWHB) during treatment was 11.6 g/dl (range 8.8–15.5). Overall, one-third of patients received blood transfusions before or during chemo-radiation, and two-thirds of patients completed five or six cycles of weekly cisplatin. Reasons for fewer than five cycles were scheduling failures, neutropenia, renal impairment and side effects. No outcome differences were observed for Monday vs. Thursday cisplatin administration. The five-year overall survival was 60%. Patients completing fewer than six cycles had a worse survival (55 vs. 76%, p = 0.02). By multiple regression for survival only six cycles of cisplatin, squamous histology and AWHB >10 g/dl were significant. Conclusions: Maintaining HB >10.0 and administering six cycles of weekly cisplatin are associated with better survival from chemo-radiation for stage IIB cervical cancer. (Full text available online at www.medpharm.tandfonline.com/ojgo) South Afr J Gynaecol Oncol 2018; DOI: 10.1080/20742835.2018.1441694

Author Biographies

Mtabeni George Jemu, Groote Schuur Hospital and University of Cape Town
Division of Radiation Oncology Groote Schuur Hospital and University of Cape Town Cape Town
Leon Van Wijk, Groote Schuur Hospital and University of Cape Town
Division of Radiation Oncology Groote Schuur Hospital and University of Cape Town Cape Town South Africa; and South African Medical Research Council Gynaecological Cancer Research Centre Cape Town
Michelle Parker, Groote Schuur Hospital and University of Cape Town
Radiobiology Section Division of Radiation Oncology Groote Schuur Hospital and University of Cape Town Cape Town
Glenn Jones, The University of the West Indies
School of Clinical Medicine and Research The University of the West Indies Nassau Bahamas
Published
2018-05-28
Section
Original Research