Five-years Outcomes of Concurrent Chemoradiationin Saudi Women with Locally Advanced Cervical Cancer

Mutahir Ali Tunio, FCPS (Rad. Onc)Radiation Oncology, Comprehensive Cancer Center

King Fahad Medical City, Riyadh

0 10 20 30 40 50Breast

ThyroidColorectal

NHLOvaryCervix

LeukemiaUterine

StomachKidney

SkinCNS

Hodgkin LOthers

Saudi Cancer Registry-2009 (30-44 years)

%

Background:

GOG-04GOG-

85/SWOG 8695

GOG-120 GOG-165 GOG-191

Background:

RT alone Vs. RT + Hydroxyurea

RT + Hydroxyurea Vs. RT + 5-FU/cisplatin

RT + 5FU/cisplatin Vs. RT + weekly cisplatin Vs. RT + Hydroxyurea

RT + weekly cisplatin Vs. RT + 5-FU protracted

Randomized trials of concurrent chemo-radiation therapy for locallyadvanced cervical cancer

RT + weekly cisplatin Vs. RT + weekly cisplatin/EPO

Cochrane Database Syst Rev. 2014

Ann Saudi Med 2013; 33(4): 327-333

Aim:

To evaluate long-term treatment outcomes and toxicity profile ofcombined Chemoradiation in Saudi women with locally advanced cervical cancer

Inclusion and Exclusion Criteria –

h/o Abdominopelvic RT

all patients

metastatic

h/o Hysterectomy/RP surgery

IIB-IVA; ECOG 0-2; CCRT study population

Materials and methods –

1. King Khalid Hospital(17.9%)

2. NGH(30.9%)

3. King Fahad Medical City

(51.2%)

incomplete data/Rx

IRB

Appr

oval

(200

7-20

12)

Materials and methods –Treatment and follow-up

IIIII IIIII IIIII IIIII IIIII IIIII/III

HDR HDR HDR1st

year

2nd

year

3rd

year

4th

year

5th

year

Follow-upPelvic exams; Pap

smear, Imaging

21 Gy @ 7 Gy x 3

Cisplatin 40 mg/m2

weekly

WK1 WK2 WK3 WK4 WK5 WK6-7

EBRT: 50.4 - 54.0 Gy/28-33 # HDR-BT

Weekly follow up; symptoms, weight, pelvic exams; CBC, electrolytes,

RT techniques –

Materials and methods –

Statistical analysis

Survival probabilities were determined by Kaplan-Meier, Log rank; Student’s unpaired t test was used to determine the difference between groups; p value <0.05 was considered significant

EndpointsPrimary: Locoregional Control

(defined as duration between the completion of CCRT and the date of documented recurrence within irradiated fields

Secondary: Distant control; disease free survival; overall survival and toxicity profile

Data collection

Demographics; Tumor characteristics; treatment details; Follow-up; toxicity (NCI-CTC and RTOG); outcomes

Results –

Results –

• Median follow up duration was 5 years (range: 0.8-5.5)

• Mean duration of RT was 56 days (range:48-58)

Results – Toxicity

Results – Locoregional Failure

L1L2L3L4L5

T12

FOLLOW UP IN MONTHS6050403020100

% L

OCOR

EGIO

NAL

CONT

ROL

1.0.9.8.7.6.5.4.3.2.1

0.0

Results – Locoregional Control

84.2%

FOLLOW UP IN MONTHS6050403020100%

DIS

TANT

MET

ASTA

TIC

CONT

ROL 1.0

.9

.8

.7

.6

.5

.4

.3

.2

.10.0

Results – Distant Metastasis Control

78.5%

FOLLOW UP IN MONTHS6050403020100

% O

VERA

LL S

URVI

VAL

1.0.9.8.7.6.5.4.3.2.1

0.0

Results – Overall Survival

64.5%(47 pts alive of analysis)

Subgroup No. of Patients

Hazard Ratio

Age Age ≤ 50 years 33Age > 50 years 41

Co-morbidities Yes 30No 44

FIGO IIB 49> IIB 25

Nodal disease Yes 45No 29

Hemoglobulin < 10 gm/dL 5> 10 gm/dL 69

Histology Adenocarcinoma/adenosquamous

7

Squamous 67Treatment duration < 54 days 65

> 54 days 9Overall 74

0.0 0.5 1.0 1.5 2.0 2.5

Results –Locoregional Control Prognostic factors

Discussion – Merits

2

3

4

Good sample size1

Long follow-up duration

Moderate doses of weekly cisplatin

Better RT techniques

5 Multidisciplinary approach

Discussion – Limitations

2

3

4

Retrospective 1

Sampling bias

Majority of Cohort with DM and HTN

Lead time bias

5 Lack of data on QoL

Outcomes in agreement

with international

data

Further results of IMRT are

warranted

Multidisciplinary approach

High No:

DM and HTN warrants public awareness

Conclusions –

LARC warrants screening

campaign in the Kingdom

Acknowledgement

• Dr. Mushabbab AlAsiri, for his constant support and encouraging forthis research

• Dr. Yasser Bayoumi, Dr. Abdulrehman AlHadab, Dr. Eyad AlSaeed, Dr.A. Amro, Mohannad Arifi (Student KSU), Radiation Oncology-KFMC,Gynecology Oncology team-KFMC and our patients for giving usopportunity to present this study in front of you

• Scientific Chair of Prof. Abdullah Hussain Basalamah for GYN Cancer;for giving the platform to present this study

Thank you ??