Factors Affecting Incomplete Remission in Advanced Cervical Cancer after Concurrent Chemoradiation
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Abstract
BACKGROUND: Cervical cancer is the most common form of gynecologic malignancy and the fourth most common cause of death from female malignancy. Poor treatment outcomes and survival are typically due to late presentation in advanced stages. Determining the factors affecting incomplete remission in advanced cervical cancer after concurrent chemoradiation may provide a guideline for the management of further surgery or combination chemotherapy, before or between concurrent chemoradiation.
OBJECTIVE: We aimed to study the factors used to predict incomplete remission in advanced cervical cancer after concurrent chemoradiation (primary outcome).
METHODS: This study utilized prognostic factor research and a retrospective case-control design of advanced cervical cancer patients (stage II-IVA) (FIGO2019) who underwent concurrent chemoradiation at the Gynecologic Oncology Unit and Radiotherapy Unit at Surin Hospital, Thailand from 1 January 2011 to 30 April 2021 and received follow-up to 30 November 2021. We classified patients into 2 group comprising complete remission and incomplete remission after 1 month of concurrent chemoradiation. We collected the baseline characteristic data, stage, ECOG, size of tumor, lymph node metastasis, cell type of cancer, waiting time to start radiation, regimen and cycle of chemotherapy between radiation cause, history of oral contraceptive pills used, amount of parity and partner, drinking, smoking and previous CIN. Univariate and multivariable regression models were used for analysis.
RESULTS: A total of 852 patients were included, with 568 patients in complete remission and 284 patients in incomplete remission. Seven significant predictors for incomplete remission were identified: Stages 3 and 4, ECOG 2-3, low BMI level, tumor size >4 cm, cell type adenocarcinoma, lymph node metastasis and drinking.
CONCLUSION: Patients who exhibit these factors should receive neoadjuvant chemotherapy to decrease the size of a tumor before surgery. If surgery with free margins proves to be inoperable, radiation is the next step. The combination of a chemotherapy regimen and radiation is an interesting alternative.
Thaiclinicaltrials.org number, TCTR20220226001
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