Comparison of compliance and response rate of radiotherapy alone vs. chemo radiotherapy in stage IIIB carcinoma cervix patients having obstructive uropathy

Narendra Rathore, Sunnia Gupta

Abstract


Background: Carcinoma cervix is the second most common malignancy among females of India (1). The low incidence rate in developed countries is because of well-developed screening programs and awareness among women. But in developing countries like India, because of lack of health awareness and lack of proper screening facilities, patients usually present in advanced stages. They also have a lot of associated co-morbidities like obstructive uropathy with or without deranged RFT, anaemia, poor nutrition, tuberculosis, diabetes, hypertension, multiple genital infections etc. The standard treatment of advanced carcinoma cervix is radiotherapy with weekly cisplatin as radio-sensitizer but it has been observed that a lot of patients are not able to tolerate toxic side effects of concurrent chemo radiotherapy.

Methods: We have chosen only one co-morbid condition i.e. obstructive uropathy with or without deranged RFT because of small sample size. So the aim of this study was to compare the compliance and response rate of concurrent chemo radiotherapy versus radiotherapy alone in patients of locally advanced carcinoma cervix having obstructive uropathy with or without deranged RFT.

Results:Only 36% (n=9) patients in the RT+CT group received the complete planned five cycles of weekly cisplatin. Average number of cycles of cisplatin missed in the chemo-radiotherapy group was one (range 0-3). Compliance was better in the RT alone group. The average time in the RT alone group to complete radiotherapy was 57.72 days and in RT+CT group was 60.72 days. In the RT alone group the treatment time was prolonged by an average of 1.72 days (range 3-6) while in the CT+RT group it was prolonged by 4.72 days (range 2-14).

Conclusions:It is hereby concluded that radiotherapy alone for locally advanced squamous cell cervical carcinoma patients having associated co morbid conditions like deranged RFT had a better compliance then with the concurrent chemoradiotherapy regime. 

 


Keywords


Carcinoma cervix, Obstructive uropathy, Co-morbidities, Radiation alone, Chemoradiation, Compliance, Response rate

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References


Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D. Global Cancer Statistics, CA Cancer J Clin 2011;61:69-90.

GLOBOCAN 2012 (IARC) Section of Cancer Information, http://globocan.iarc.fr/factsheet.asp.

Edward C. Halperin, Luther W. Brady. The Discipline of Radiation Oncology: Principles and practice of Radiation Oncology. 4th Edition page No: 3, 2004.

Vaupel P, Thews O, Mayer A, Hockel S, Hockel M. Oxygenation status of Gynaecologic tumours: what is the optimal hemoglobin level? Strahlenther Oncol 2007;178:727- 31.

Monk BJ, Tian C, Rose PG, Lanciano R. Which clinical/ pathologic factors matter in the era of chemo radiation as treatment for locally advanced cervical carcinoma? Analysis of two Gynaecologic Oncology Group (GOG) trials. Gynaecol Oncol 105, 427-33.

Vale C. Reducing uncertainties about the effects of chemo radiotherapy for cervical cancer: a systematic review and meta-analysis of individual patient data from 18 randomized trials. J Clin Oncol 2008;26: 5802-12.

Serkies K, Jassem J. Concurrent weekly cisplatin and radiotherapy in routine management of cervical cancer: a report on patient compliance and acute toxicity. Int J Radiat Oncol Biol Phys 2004;60:814-21.

Keys HM, Bundy BN, Stehman FB. Cisplatin, radiation, and adjuvant hysterectomy compared with radiation and adjuvant hysterectomy for bulky stage IB cervical carcinoma. N Engl J Med 1999;340: 1154-61.

Rose PG, Bundy BN, Watkins EB, et al. Concurrent cisplatin-based radiotherapy and chemotherapy for locally advanced cervical cancer. N Engl J Med 1999;340:1144-53.

Whitney CW, Sause W, Bundy BN, et al. Randomized comparison of fluorouracil plus cisplatin versus hydroxyurea as an adjunct to radiation therapy in stage IIB-IVA carcinoma of the cervix with negative para-aortic lymph nodes: a Gynaecologic Oncology Group and Southwest Oncology Group study. J Clin Oncol 1999;17:1339-48.

Abu-Rustum NR, Lee S, Correa A, Massad LS. Compliance with and acute hematologic toxic effects of chemoradiation in indigent women with cervical cancer. Gynecol Oncol 2001;81:88-91.

Rose PG. Chemo radiotherapy for cervical cancer. Eur J Cancer 2002;38:270-8.

Einstein MH, Novetsky AP, Garg M, et al.. Survival and toxicity differences between 5-day and weekly cisplatin in patients with locally advanced cervical cancer. Cancer 2007;109:48-53.

Perez CA, Grigsby PW, Castro-Vita H, Lockett MA. Carcinoma of the uterine cervix. I. Impact of prolongation of overall treatment time and timing of brachytherapy on outcome of radiation therapy. Int J Radiat Oncol Biol Phys 1995;32:1275-88.

Chen SW, Liang JA, Yang SN, KO HL, Lin FJ. The adverse effect of treatment prolongation in cervical cancer by high-dose-rate intracavitary brachytherapy. Radiother Oncol 2003;67:69-76.

Bosch FX, de Sanjose S. Human papillomavirus and cervical cancer burden and assessment of causality. J Natl Cancer Inst Monogr 2003:3.

Subir Nag, Beth Eriskson, Bruce Thomadsen, Colin Orton, Jeffrey D. Demanes, and Daniel Petereit. The American Brachytherapy Society recommendations for High-Dose-Rate Brachytherapy for carcinoma of the cervix. Int. J. Radiation Oncology Biol. Phys 2000;48:201–211.

Firuza D Patel. Cancer cervix: Treatment and its problems: Health Administrator 17:162-168.

Barillot I, Horiot JC, and Pigneux J, et al. Carcinoma of the intact uterine cervix treated with radiotherapy alone: A French cooperative study: update and multivariate analysis of prognostics factors. Int J Radiat Oncol Biol Phys 1997;38:969.

Fowler JF, Lindstrom MJ. Loss of local control with prolongation in radiotherapy. Int J Radiat Oncol Biol Phys 1992;23:457.

Carlos A. Perez, Robart Zwicker. Clinical applications of Brachytherapy- Principles and practice of radiation Oncology. 4th Edition 2004. P. 538.

Eifel PJ. High-dose rate brachytherapy for Carcinoma for Cervix: High tech or High risk. Int J Radiat Oncol Biol phys 1992;24:383-386.

Tod M, Meredith W. A dosage system for use in the treatment of cancer of the uterine cervix. Br J Radiol 1938;11:809–824.

Grinsky T, Rey A, Roche B, et al.. Overall treatment time in advanced cervical carcinomas: A critical parameter in treatment outcome. Int J Radiat Oncol Biol Phys 1993;27:1051–1056.

Petereit DG, Sarkaria JN, Hartmann TJ, et al. Adverse effect of treatment prolongation in cervical carcinoma. Int J Radiat Oncol Biol Phys 1995;32: 1301–1307.

Saibishkumar EP, Patel FD, Sharma SC. Results of radiotherapy alone in the treatment of carcinoma of uterine cervix: a retrospective analysis of 1069 patients. Int J Gynaecol Cancer 2005;15:890–897.

Green JA, Kirwan JM, Tierney JF, Symonds P, Fresco L, Collingwood M, Williams CJ. Survival and recurrence after concomitant chemotherapy and radiotherapy for cancer of the uterine cervix: a systematic review and meta-analysis. Lancet 2001; 358:781-6.

Kim RY, Alvarez RD. Recent developments in chemo radiotherapy for locally advanced cancer of the cervix. Oncol 2000;14:1327-35.

Green J, Kirwan J, Tierney J, Vale C, Symonds P, Fresco L, Williams C, Collingwood M. Concomitant chemotherapy and radiation therapy for cancer of the uterine cervix. Cochrane Database Syst Rev 2005, CD002225.

Toita T, Moromizato H, Ogawa K, Kakinohana Y, Maehama T, Kanazawa K, Murayama S. Concurrent chemo radiotherapy using high-dose-rate intracavitary brachytherapy for uterine cervical cancer. Gynaecol Oncol 2005;96:665-70.

Ikushima H, Osaki K, Furutani S, Yamashita K, Kawanaka T, Kishida Y, Iwamoto S, Takegawa Y, Kudoh T, Nishitani H. cisplatin. Radiat Med 2006;24:115-21.

Nias AH. Radiation and platinum drug interaction. Int J Radiat Biol Relat Stud Phys Chem Med 1985;48:297-314.

Seiwert T Y, Salama J K, Vokes E. The concurrent chemo radiation paradigm --general principles. Nat 2007;4:86-100.

Thigpen T, Shingleton H, Homesley H, et al. cis-Dichlorodiammineplatinum( II) in the treatment of Gynaecologic malignancies: Phase II trials by the Gynaecologic Oncology Group. Cancer Treat Rep 1979;63:1549–55.

Shanta V1, Krishnamurthi S, Gajalakshmi CK, Swaminathan R, Ravichandran K. Epidemiology of cancer of the cervix: global and national perspective. J Indian Med Assoc.2000 Feb;98(2):49-52.