International Journal of Hematology and Oncology 2018, Vol 28, Num 1 Page(s): 019-029
Definitive Treatment for Locally Advanced Cervical Cancer: A Retrospective Analysis from A Singe Institution

Sumerya DURU BIRGI1, Melis GULTEKIN2, Deniz YUCE3, Ferah YILDIZ2

1Gazi Yasargil Research and Training Hospital, Department of Radiation Oncology, Diyarbakir, TURKEY
2Hacettepe University Faculty of Medicine, Department of Radiation Oncology, Ankara, TURKEY
3Hacettepe University Faculty of Medicine, Department of Preventive Oncology, Ankara, TURKEY

Keywords: Locally advanced, Cervix cancer, Chemoradiotherapy, Treatment response, Prognosis
The primary aim of this study was to evaluate the long-term treatment outcomes of definitive chemoradiotherapy (CRT) of locally advanced cervical cancer and beside this to identify prognostic factors and related toxicities. Between February 2001 and September 2013, 327 patients were retrospectively evaluated. The median age was 56 years (range, 24-82 years). Ninety-five percent of patients had ≥Stage IIB disease. External pelvic radiotherapy (RT) (45-50.4 Gy) and concomitant chemotherapy followed by 28 Gy in 4 fractions high dose rate brachytherapy was administered. Boost doses of 10-15 Gy were administered to <2 cm lymph nodes (LNs) or distal parametrial involved sites. The median follow-up time was 68 months (range, 45-90 months). Two-, 5- and 10-year cancer specific survival (CSS) rates were 80%, 68%, and 65%; disease-free survival (DFS) rates were 73%, 66%, and 64%; local recurrence-free survival (LRFS) rates were 94%, 92%, and 91%; loco-regional recurrence-free survival (LRRFS) were 92%, 89%, and 86%; distant metastases-free survival (DMFS) were 81%, 76%, 75%, respectively. In multivariate analysis, age, clinical stage and LN metastasis at diagnosis were independent prognostic factors for both CSS and DFS. Third month response to treatment was the most important prognostic factor for all end points in univariate and multivariate analysis. With the aggressive radiotherapeutic approach, it seems that distant metastases rather than locoregional recurrence determines the survival rates. Consolidation chemotherapy may be a good option after definitive CRT which needs to be supported with future phase III studies.