Retrospective review of 37.4 Gy in 11 fractions for the palliation of advanced cervical cancer

Abstract

Background Bleeding, pain and discharge are common symptoms of cervical cancer that can be effectively palliated with radiotherapy. Aim To evaluate the effectiveness of an external beam radiotherapy dose of 37.4 Gy in 11 fractions for the local palliation of advanced cervical cancer. Methods This study is a retrospective review of all patients receiving palliative radiotherapy (37.4 Gy in 11 fractions) at the Department of Oncology, Universitas Hospital, Bloemfontein South Africa, from 2009 to 2013. The data from 324 cases were analysed. Data obtained included patient age, ECOG performance status, FIGO staging, histological type and grade, HIV status and CD4 count. The presence of renal impairment and patient-reported symptoms before and after treatment, as well as the duration of therapy, was also documented. The five-year overall survival was determined from available follow-up data. Results The majority of patients (50.9%) were between 40 and 59 years of age, 138 (42.6%) were HIV-positive and most patients presented with FIGO stage 4 disease 228 (70.4%). Squamous cell carcinoma (SCC) was the most frequent histological type (n = 292; 90.4%). Tumour grade was well differentiated in 16 (4.9%) patients, moderately differentiated in 171 (52.8%) cases and poorly differentiated in 113 (34.9%). Most patients reported relief of symptoms one month post-treatment: 76.6% of patients reported improvement of pain, while bleeding and discharge had resolved in 99.5% and 79.3% of patients, respectively. Similar observations were noted at 3-, 6- and 12-month follow-up. Morphine analgesia was required in less than 10% of patients over the 12 month follow-up period. Of the initial cohort, 11 (3.4%) patients were still alive five years after completing palliative radiotherapy.