Gynecological Cancer

PV QA 4 - Poster Viewing Q&A 4

TU_13_3448 - Single Institution Results of IMRT for Locally Advanced Intact Cervical Cancer in an Urban Health Setting

Tuesday, October 23
2:45 PM - 4:15 PM
Location: Innovation Hub, Exhibit Hall 3

Single Institution Results of IMRT for Locally Advanced Intact Cervical Cancer in an Urban Health Setting
A. C. Berkowitz1, K. J. Mehta1, R. P. Gatto1, R. Kabarriti1, S. Viswanathan1, R. Yaparpalvi1, N. Ohri1, D. Kuo2, and S. Kalnicki1; 1Department of Radiation Oncology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, 2Montefiore Medical Center, Bronx, NY

Purpose/Objective(s): To demonstrate competitive outcomes and a low toxicity profile, despite prolonged treatment package time in patients with intact cervical cancer treated with Intensity Modulated Radiation Therapy (IMRT) and brachytherapy at our institution.

Materials/Methods: We conducted a retrospective review of 126 patients with FIGO Stage IB1-IVA intact cervical cancer, treated with a definitive course of IMRT, followed by High Dose Rate (HDR) brachytherapy at our institution between 2005 and 2013. Seventy-five percent of patients received at least 4 cycles of concurrent weekly cisplatin. Greater than 90% of patients were treated with 45Gy in 25 fractions to the pelvis, and 66% of patients received paraaortic radiation. Patient clinical characteristics were collected including acute and late GI, GU, and vaginal toxicities (according to CTCAE 4.0), and radiation treatment duration. Overall survival, loco-regional recurrence, and distant recurrence rates were examined using Kaplan-Meier survival procedures along with the log rank test. The Cox model was used to examine risk between treatment duration and time-to-event outcomes.

Results: Forty-one percent of patients identified as black, 18% white, 6% Hispanic, and 35% were of unknown ethnicity. There were 86 patients with Stage I-II disease (69%) and 40 patients (31%) had Stage III-IVA disease. Squamous histology was present in 89% of patients. Median follow up was 41 months (range: 0.13, 131). Eighteen (14%) expired, 26 (20.6%) had loco-regional recurrence, and 36 (29%) had distant recurrence. The probability of overall survival at 1 and 5 years were 93 and 82%, respectively. The probability of no loco-regional and distant recurrences at 1 and 5 years were 86% and 75%, and 77% and 67%, respectively. A high hazard ratio of 5.7, 4.2 and 6.2 for death was observed for those that completed treatment within 9-10 weeks, 11-12 weeks and >12 weeks compared with ≤9 weeks, though not statistically significant. The most common reasons for treatment delay in this cohort were patient noncompliance, abnormal lab values, and OR availability for brachytherapy. Acute Grade 3-4 toxicities were: 5% GI, 2% GU, and 2% vaginal. Late Grade 3-4 toxicities were: 9% GI, 11% GU, and 9% vaginal.

Conclusion: Definitive IMRT with concurrent weekly cisplatin and brachytherapy allows disease control and a low toxicity profile in locally advanced cervical cancer. Minimizing delays in radiation treatment has important implications for optimizing survival outcomes. We have also shown that overall favorable outcomes are still possible in a population where treatment delays are a challenge. Identifying potential barriers to timely treatment is a crucial step in quality improvement for our patients. Further studies are warranted with regards to socioeconomic status and hospital resource allocation and their effects on treatment duration.

Author Disclosure: A.C. Berkowitz: None. K.J. Mehta: None. R. Kabarriti: None. R. Yaparpalvi: None. N. Ohri: None. D. Kuo: None. S. Kalnicki: Travel Expenses; Varian Oncology Systems. Committee Member; American College of Radiology.

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