Hostname: page-component-848d4c4894-cjp7w Total loading time: 0 Render date: 2024-06-23T02:30:45.287Z Has data issue: false hasContentIssue false
  • English
  • Français

Patterns of care and clinical outcomes in stage IVA cervical cancer: 14-year experience from a tertiary care centre in South India

Published online by Cambridge University Press:  10 December 2021

Neenu Oliver John ,
Arvind Sathyamurthy ,
Shanthi Prasoona ,
Jeba Karunya Ramireddy Open the ORCID record for Jeba Karunya Ramireddy [Opens in a new window] ,
Grace Rebekah ,
Saikat Das ,
Reena Mary George ,
Subhashini John  and
Thomas Samuel Ram
Neenu Oliver John
Affiliation:
Dr Ida B Scudder Cancer Centre, Department of Radiation Oncology, Christian Medical College, Vellore, Tamil Nadu, India.
Arvind Sathyamurthy
Affiliation:
Dr Ida B Scudder Cancer Centre, Department of Radiation Oncology, Christian Medical College, Vellore, Tamil Nadu, India.
Shanthi Prasoona
Affiliation:
Palliative Care Unit, Christian Medical College, Vellore, Tamil Nadu, India
Jeba Karunya Ramireddy*
Affiliation:
Dr Ida B Scudder Cancer Centre, Department of Radiation Oncology, Christian Medical College, Vellore, Tamil Nadu, India.
Grace Rebekah
Affiliation:
Department of Biostatistics, Christian Medical College, Vellore, Tamil Nadu, India
Saikat Das
Affiliation:
Dr Ida B Scudder Cancer Centre, Department of Radiation Oncology, Christian Medical College, Vellore, Tamil Nadu, India. Department of Radiation Oncology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
Reena Mary George
Affiliation:
Department of Continuing Medical Education, Christian Medical College, Vellore, Tamil Nadu, India
Subhashini John
Affiliation:
Dr Ida B Scudder Cancer Centre, Department of Radiation Oncology, Christian Medical College, Vellore, Tamil Nadu, India.
Thomas Samuel Ram
Affiliation:
Dr Ida B Scudder Cancer Centre, Department of Radiation Oncology, Christian Medical College, Vellore, Tamil Nadu, India.
*
Author for correspondence: Jeba Karunya Ramireddy, Associate Professor, Department of Radiation Oncology unit 1, Dr. Ida B Scudder Cancer Centre, Christian Medical College, Vellore, Tamil Nadu, India. Emails: jebakarunyadaniel@gmail.com; jeba_kr@cmcvellore.acin
Get access Rights & Permissions [Opens in a new window]

Abstract

Aim:

To analyse the patterns of care and clinical outcomes of patients diagnosed with cervical cancer International Federation of Gynecology and Obstetrics (FIGO) stage IVA treated at a tertiary care centre in South India.

Materials and methods:

The electronic medical records of 2,476 patients diagnosed with cervical cancer at a tertiary care institution between January 2005 and December 2018 were reviewed. Among them, 96 patients diagnosed with histologically proven carcinoma cervix stage IVA established by either cystoscopy or proctoscopy were included. Four patients who did not receive treatment at the study centre were excluded and 92 patients were available for final analysis.

Results:

The median follow-up period was 12 months (2–131 months). Of the 92 patients, 59 patients (64·13%) received radiation therapy (RT) alone, 22 patients (23·9%) received chemoradiation (CRT), three patients (3·26%) received neoadjuvant chemotherapy (NACT) followed by RT, one (1·08%) received NACT followed by CRT, four patients (4·35%) received chemotherapy alone, while three (3·26%) were offered best supportive care. The median progression-free survival (PFS) was 12 months (95% CI: 9·6–14·4 months) and median overall survival (OS) was 25 months (95% CI: 16·6–33·4 months). The 2-year and 3-year PFS was 30 and 20%, respectively, and the OS was 50 and 32%, respectively.

Conclusion:

The management of stage IVA cervical cancer needs to be individualised to achieve a fine balance between local control, toxicity, and quality of life. RT is the mainstay of treatment with concurrent chemotherapy in carefully selected patients. Involvement of palliative care team early in the course of treatment adds a holistic approach to the continuum of oncological care.

Keywords

Cancer PainCarcinoma Cervix IVAChemoradiationLocally Advanced Cervical CancerPalliative Care
Type
Original Article
Information
Journal of Radiotherapy in Practice , Volume 22 , 2023 , e9
Check for updates
Copyright
© The Author(s), 2021. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Bray, F, Ferlay, J, Soerjomataram, I, Siegel, R L, Torre, L A, Jemal, A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2018; 68 (6): 394–424.CrossRefGoogle ScholarPubMed
LaVigne, A W, Triedman, S A, Randall, T C, Trimble, E L, Viswanathan, A N. Cervical cancer in low and middle income countries: Addressing barriers to radiotherapy delivery. Gynecol Oncol Rep 2017; 22: 16–20.CrossRefGoogle ScholarPubMed
Bhatla, N, Berek, J S, Fredes, M C et al. Revised FIGO staging for carcinoma of the cervix uteri. Int J Gynecol Obstet 2019; 145 (1): 129–135.CrossRefGoogle ScholarPubMed
Chopra, S, Gupta, M, Mathew, A et al. Locally advanced cervical cancer: a study of 5-year outcomes. Indian J Cancer 2018; 55 (1): 45.CrossRefGoogle ScholarPubMed
George, R, Das, S, Jeba, J. Cancer and treatment related pains in patients with cervical carcinoma. Indian J Palliat Care 2005; 11 (2): 74.CrossRefGoogle Scholar
Mishra, K. Gynaecological malignancies from palliative care perspective. Indian J Palliat Care 2011; 17 (4): 45.CrossRefGoogle ScholarPubMed
Allende-Pérez, S, Verástegui-Avilés, E, Mohar-Betancourt, A, Herrera-Gómez, A. Integrated oncology and palliative care: five years experience at the National Cancer Institute of Mexico. Salud Pública México 2016; 58 (2): 317–324.CrossRefGoogle ScholarPubMed
Reichheld, A, Mukherjee, PK, Rahman, SM, David, KV, Pricilla, RA. Prevalence of Cervical Cancer Screening and Awareness among Women in an Urban Community in South India—a cross sectional study. Ann Glob Health 2020; 86 (1): 30.CrossRefGoogle Scholar
Shrivastava, S, Mahantshetty, U, Engineer, R et al. Cisplatin Chemoradiotherapy vs Radiotherapy in FIGO Stage IIIB Squamous Cell Carcinoma of the Uterine Cervix: a randomized clinical trial. JAMA Oncol 2018; 4 (4): 506.CrossRefGoogle ScholarPubMed
Mabuchi, S, Isohashi, F, Okazawa, M et al. Chemoradiotherapy followed by consolidation chemotherapy involving paclitaxel and carboplatin and in FIGO stage IIIB/IVA cervical cancer patients. J Gynecol Oncol 2017; 28 (1): e15.CrossRefGoogle ScholarPubMed
Rose, PG, Ali, S, Whitney, CW, Lanciano, R, Stehman, FB. Outcome of stage IVA cervical cancer patients with disease limited to the pelvis in the era of chemoradiation: a gynecologic oncology group study. Gynecol Oncol 2011; 121 (3):542–545.CrossRefGoogle Scholar
Nuranna, L, Antonius, PA, Laily, AN, Kusuma, F, Nuryanto, KH. IIIB-plus: a new classification recommended for stage IIIB cervical cancer patients with renal impairment. J Nat Sci Biol Med 2019; 10 (3): 113.Google Scholar
Espenel, S, Garcia, MA, Langrand-Escure, J et al. Special focus on stage IV Cervical Cancer patients: a decade experience. Oncology 2019; 97 (3): 125–134.CrossRefGoogle ScholarPubMed
Hata, M, Koike, I, Miyagi, E et al. Radiation therapy for stage IVA uterine cervical cancer: treatment outcomes including prognostic factors and risk of vesicovaginal and rectovaginal fistulas. Oncotarget 2017; 8 (68): 112855–112866.CrossRefGoogle ScholarPubMed
Murakami, N, Kasamatsu, T, Morota, M et al. Radiation therapy for stage IVA cervical cancer. Anticancer Res 2013; 33 (11): 4989–4994.Google ScholarPubMed
Mishra, K, Desai, A, Patel, S, Mankad, M, Dave, K. Role of percutaneous nephrostomy in advanced cervical carcinoma with obstructive uropathy: a case series. Indian J Palliat Care 2009; 15 (1): 37–40.CrossRefGoogle ScholarPubMed
Moore, KN, Gold, MA, McMeekin, DS, Zorn, KK. Vesicovaginal fistula formation in patients with Stage IVA cervical carcinoma. Gynecol Oncol 2007; 106 (3): 498–501.CrossRefGoogle ScholarPubMed
Biewenga, P, Mutsaerts, MAQ, Stalpers, LJ, Buist, MR, Schilthuis, MS, van der Velden, J. Can we predict vesicovaginal or rectovaginal fistula formation in patients with stage IVA cervical cancer? Int J Gynecol Cancer Off J Int Gynecol Cancer Soc 2010; 20 (3): 471–475.CrossRefGoogle ScholarPubMed
Sun, R, Koubaa, I, Limkin, EJ, Dumas, I et al. Locally advanced cervical cancer with bladder invasion: clinical outcomes and predictive factors for vesicovaginal fistulae. Oncotarget 2018; 9 (10): 9299–9310.CrossRefGoogle ScholarPubMed
Khulpateea, BR, Paulson, A, Carlson, M, Miller, DS, Lea, J. Stage IVA cervical cancer: outcomes of disease related complications and treatment. Int J Gynecol Cancer Off J Int Gynecol Cancer Soc 2021; 31 (4): 518–523.CrossRefGoogle ScholarPubMed
Palat, G, Biji, MS, Rajagopal, MR. Pain management in cancer cervix. Indian J Palliat Care 2005; 11 (2): 64.CrossRefGoogle Scholar
Jadad, AR, Browman, GP. The WHO analgesic ladder for cancer pain management: stepping up the quality of its evaluation. J Am Med Assoc 1995; 274 (23): 1870–1873.CrossRefGoogle ScholarPubMed
Supplementary material: File

John et al. supplementary material

John et al. supplementary material

Download John et al. supplementary material(File)
File 17.7 KB