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

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.