Impact of concomitant chemotherapy on the effects of overall treatment time in Cervical Cancer
Abstract
AIM --This is a retrospective study aimed at analyzing the effect of treatment prolongation
time in the era of concomitant chemo radiation in cervical cancer.Material and methods --652 patients
treated with a curative intent in our institute between Jan2006 to Dec2007 were retrospectively
analyzed in this study. It was carried out considering treatment prolongation time as being 60
calendar days in patients treated with CRT. The cumulative incidence of failures and effect of overall
treatment time on the survival was analyzed considering various factors such as age, histology, grade
and stage of cancer.Results --The 652 patients were analyzed based on the above said stratification.
Out of these, 370 patients were treated with radiotherapy alone and 282 patients received
concomitant chemoradiation. The total number of failures was 131(20) irrespective of the stage of
disease. The 5-yearDFS of patients treated with concomitant chemoradiation was found to be 71.
Among these, the median survival among patients who had delay and who did not have delay in
treatment was 73.5 vs 78.7 months respectively (p0.0001). The difference in survival seen in patients
who were treated with concurrent chemoradiation who did and did not have delay in treatment was
found to be statistically significant with a p value of 0.0004 and patients treated with radiotherapy
alone showed (p0.0002).When a multivariate analysis was done by considering confounding factors
such as stage, age and histology, there was no statistical significance found but in a subset analysis
there was a significant survival difference when patients with locally advanced and early stage
cervical cancer were compared with and without delay. Conclusion -- Prolongation of treatment
duration does have a negative effect on survival. Concurrent chemo radiation loses its benefit when
treatment time prolonged. Hence completion of radiation in time is always important. Judicious use of
chemotherapy and meticulous assessment of patients for toxicity will help to extract the complete
benefit of chemo radiation in carcinoma cervix.
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