TITLE:
Outcomes of External-Beam Radiation Therapy Boost with Conventional Fractionation in Cervical Cancer: A Retrospective Analysis about 133 Cases
AUTHORS:
Evrard Narcisse Séka, Bertrand Ghislain Compaoré, Bassané Alain Wilfried Mossé, Siham Jaba, Kouadio Davy N’chiépo, Maroua Benlemlih, Hasnae Bouhia, Mohammed Adnane Tazi, Sanae El Majjaoui, Noureddine Benjaafar
KEYWORDS:
Cervical Cancer, External Beam Radiation Therapy Boost, Survival, Prognostic Factors
JOURNAL NAME:
Journal of Cancer Therapy,
Vol.11 No.9,
September
25,
2020
ABSTRACT: Introduction: External-beam radiation therapy boost is a treatment option in cervical cancer
when brachytherapy is not feasible. Though less effective than brachytherapy, some
encouraging results have been reported from some institutions experiences. We conducted
this study to assess outcomes of EBRT boost for our patients at National Institute
of Oncology in Rabat. Patients and Methods: We collected data from patients
treated for cervical cancer between January 2012 and December 2015. Patients, tumor
and treatment characteristics were collected. Overall survival (OS), disease-free
survival (DFS) and prognostic factors influencing DFS were assessed. Results: One hundred and thirty-three patients were enrolled. Median age was 52 years. Patient
haemoglobin level ranged from 3.9 to 15.5 g/dl [mean: 11.2 g/dl]. Most tumors were classified stage
III/IVA (63.2%) according to the FIGO classification. Regional lymph node metastases
(pelvic and or para-aortic) were observed in 45.1%. Median total dose to tumor was
69.6 Gy (ranging from 66 to 70 Gy). Overall treatment time was protracted, with
a median of 60 days. Most of patients received concurrent chemotherapy (94.7%) and
the number of cycle ranged from 2 to 7 (median = 5). The
follow-up median was 31.3 months, ranging from 6.2 to 96.8 months. At the first
visit, most patients achieved complete response (80.5%). Five years OS and DFS were
47% and 44% respectively. In univariate and multivariate analysis, regional lymph
nodes metastasis (presence or absence) and haemoglobin level (≤11 g/dl and >11 g/dl) were the two significant
and independent prognostic factors influencing DFS (HR: 1.86; p = 0.01 for the former) (HR: 0.59; p = 0.03 for the latter). Conclusion: Our study showed
that EBRT boost in conventional fractionation was an acceptable treatment option
for cervical cancer unamenable to brachytherapy, especially in the two subgroups
of patients that are those without pelvic and/or para-aortic lymph node metastasis
and those with haemoglobin level above 11 g/dl.