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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,
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 –
• Median follow up duration was 5 years (range: 0.8-5.5)
• Mean duration of RT was 56 days (range:48-58)
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