Percutaneous parametrial dose escalation in women with advanced cervical cancer: feasibility and efficacy in relation to long-term quality of life

Sati Akbaba; Jan Tobias Oelmann-Avendano; Tilman Bostel; Harald Rief; Nils Henrik Nicolay; Juergen Debus; Katja Lindel; Robert Foerster

Accesso libero

Percutaneous parametrial dose escalation in women with advanced cervical cancer: feasibility and efficacy in relation to long-term quality of life

Sati Akbaba

Jan Tobias Oelmann-Avendano

| 11 set 2018

Radiology and Oncology

Volume 52 (2018): Numero 3 (September 2018)

INFORMAZIONI SU QUESTO ARTICOLO

Articolo precedente

Articolo Successivo

Cita

Article Category: Research Article

Pubblicato online: 11 set 2018

Pagine: 320 - 328

Ricevuto: 14 feb 2018

Accettato: 09 mag 2018

DOI: https://doi.org/10.2478/raon-2018-0029

© 2018 Sati Akbaba, Jan Tobias Oelmann-Avendano, Tilman Bostel, Harald Rief, Nils Henrik Nicolay, Juergen Debus, Katja Lindel, Robert Foerster, published by Sciendo

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

Overall survival dependent on parametrial equivalent dose in 2-Gy fractions (EQD2) with α/β = 10.

Prognostic factors for patients’ long-term quality of life (EORTC QLQ-C30, QLQ-CX24)

	n	mean	SD	p-value
Diarrhea
Acute GI 0	11	12.1	16.8	0.053
Acute GI I/II	15	35.6	32.0
Acute GI III/IV	5	46.7	38.0
Constipation
Parametria ≤ 53 Gy^{expressed as equivalent dose in 2-Gy fractions (EQD2) with α/β = 10}	19	14.0	23.1	0.057
Parametria > 53 Gy^{expressed as equivalent dose in 2-Gy fractions (EQD2) with α/β = 10}	11	33.3	29.8
Symptom experience
Acute GI toxicity 0	11	9.4	8.6	0.038
Acute GI toxicity I/II	14	20.6	15.9
Acute GI toxicity III/IV	5	30.3	22.7
Acute GU toxicity 0	5	14.3	12.9	0.041
Acute GU toxicity I/II	22	22.4	9.7
Acute GU toxicity III/IV	3	38.4	33.5
Menopausal symptoms
≤ 49 years	7	57.1	25.2	0.033
50–59 years	12	36.1	36.1
60–69 years	7	14.3	26.2
≥ 70 years	4	8.3	16.7
Sexual / vaginal functioning
T1/2	9	93.5	11.6	0.012
T3/4	3	41.7	52.0
Parametria ≤ 53 Gy^{expressed as equivalent dose in 2-Gy fractions (EQD2) with α/β = 10}	8	96.9	6.2	0.009
Parametria > 53 Gy^{expressed as equivalent dose in 2-Gy fractions (EQD2) with α/β = 10}	4	47.9	44.2
Sexual worry
Parametria ≤ 53 Gy^{expressed as equivalent dose in 2-Gy fractions (EQD2) with α/β = 10}	17	15.7	26.6	0.009
Parametria > 53 Gy^{expressed as equivalent dose in 2-Gy fractions (EQD2) with α/β = 10}	9	51.8	37.7

Quality of life of patients compared to reference populations (EORTC QLQ-C30)

	n	mean	SD	p-value
Global health status
Reference	1309	74.5	15.5	0.001
Patients	30	60.3	21.7
Physical functioning
Reference	1309	91.5	15.5	< 0.001
Patients	30	73.6	19.6
Role functioning
Reference	1309	89.9	20.6	< 0.001
Patients	31	58.1	33.0
Emotional functioning
Reference	1309	83.2	19.3	0.001
Patients	31	65.1	26.7
Cognitive functioning
Reference	1309	93.4	14.6	< 0.001
Patients	31	73.2	28.4
Social functioning
Reference	1309	93.3	17.1	< 0.001
Patients	31	69.9	29.0
Fatigue
Reference	1309	16.4	21.4	< 0.001
Patients	31	51.6	28.0
Nausea / Vomiting
Reference	1309	2.4	9.6	0.030
Patients	31	11.3	21.7
Pain
Reference	1309	17.0	24.2	0.025
Patients	31	26.9	24.2
Dyspnea
Reference	1309	7.2	18.7	0.020
Patients	30	18.9	25.8
Insomnia
Reference	1309	13.0	23.6	< 0.001
Patients	31	40.9	36.2
Appetite loss
Reference	1309	4.2	13.9	0.002
Patients	31	21.5	27.7
Constipation
Reference	1309	3.1	12.1	< 0.001
Patients	31	22.6	27.7
Diarrhea
Reference	1309	2.9	12.7	< 0.001
Patients	31	29.0	30.7
Financial difficulties
Reference	1309	4.8	16.3	< 0.001
Patients	31	29.0	29.5

Treatment and toxicity

Radiotherapy dose in EQD2 (α/β = 10)
Median EBRT		44 Gy
Range EBRT		35–51 Gy
Median parametria		53 Gy
Range parametria		38–67 Gy
Median HDR-BT		40 Gy
Range HDR-BT		10–50 Gy

	n	%

Radiotherapy technique
IMRT	58	69.9%
3D-conformal	25	30.1%
Parametrial boost
No boost	36	43.4%
Sequential	31	37.3%
SIB	16	19.3%
Parametrial dose in EQD2 (α/β = 10)
≤ 53 Gy	56	67.5%
> 53 Gy	27	32.5%
Simultanous chemotherapy
Cisplatin 40 mg/m²	71	85.5%
None	12	14.5%
Total treatment duration
< 6 weeks	9	10.8%
6-8 weeks	52	62.7%
≥ 9 weeks	22	26.5%
Anemia during therapy
min. Hb < 10 g/dl	38	45.8%
min. Hb ≥ 10 g/dl	45	54.2%
Transfusions
≤ 2 ECs	69	83.1%
> 2 ECs	14	16.9%
Observed acute GI toxicity
Grade 0	33	39.8%
Grade I	15	18.1%
Grade II	20	24.1%
Grade III	12	14.5%
Grade IV	3	3.6%
Observed acute GU toxicity
Grade 0	15	18.1%
Grade I	34	41.0%
Grade II	28	33.7%
Grade III	6	7.2%

Patients’ characteristics

Age
Median	57 years
Range	32–90 years

	n	%

Histology
Squamous cell carcinoma	67	80.7%
Adenocarcinoma	14	16.9%
Adenosquamous carcinoma	2	2.4%
Grading
G1	8	9.6%
G2	24	28.9%
G3	35	42.2%
GX	16	19.3%
FIGO stage
I	2	2.4%
II	4O	48.2%
III	15	18.1%
IV	26	31.3%
Tumour size
T1	3	3.6%
T2	46	55.4%
T3	25	30.1%
T4	9	10.8%
Lymph node status
N0	28	33.7%
N1	55	66.3%
Distant metastases
M0	64	77.1%
M1a	12	14.5%
M1c	7	8.4%

Prognostic factors for survival

OS	Univariate analysis (log-rank test)

	Mean (months)	p-value
FIGO stage
FIGO I/II	72.6	0.015
FIGO III/IV	50.8
Tumour size
T1/2	69.2	0.036
T3/4	50.4
Grading
G1/2	72.4	0.053
G3	50.5
Parametrial boost
yes	69.9	0.037
no	51.2

Parametrial dose in EQD2 (α/β= 10)

≤ 50 Gy	50.7	0.020
> 50 Gy	71.5
≤ 53 Gy	59.5	0.194
> 53 Gy	64.1
Chemotherapy
yes	67.4	0.004
no	32.1
Total treatment duration
6–8 weeks	71.6	0.027
≥ 9 weeks	44.7
Anemia during therapy
min. Hb < 10 g/dl	52.1	0.039
min. Hb ≥ 10 g/dl	70.3
Transfusions
≤ 2 ECs	67.6	0.007
> 2 ECs	41.6

LPFS	Mean (months)	p-value

FIGO stage
FIGO I/II	85.9	0.072
FIGO III/IV	66.7
Tumour size
T1/2	85.7	0.034
T3/4	64.1
Parametrial boost
yes	84.1	0.095
no	56.1

DPFS	Mean (months)	p-value

Lymph node status
N0	85.6	0.038
N1	61.0
Distant metastases
M0/M1a	75.2	0.002
M1c	37.1
Grading
G1/2	84.6	0.037
G3	59.8

Multivariate analysis (Cox regression)

OS	HR	95% CI	p-value

Parametrial boost
yes	0.417	0.192-0.900	0.027
no	Reference
Chemotherapy
yes	0.382	0.152-0.961	0.041
no	Reference

LPFS	HR	95% CI	p-value

Tumour size
T1/2	Reference
T3/4	2.668	1.032-6.896	0.043

DPFS	HR	95% CI	p-value

Lymph node status
N0	Reference
N1	4.383	1.003-19.154	0.05
Distant metastases
M0/M1a	Reference
M1c	4.646	1.466-14.719	0.009

eISSN:: 1581-3207
Lingua:: Inglese

Frequenza di pubblicazione:: 4 volte all'anno
Argomenti della rivista:: Medicine, Clinical Medicine, Radiology, Internal Medicine, Haematology, Oncology

Feed RSS della rivista

Percutaneous parametrial dose escalation in women with advanced cervical cancer: feasibility and efficacy in relation to long-term quality of life

Article Category: Research Article

Pubblicato online: 11 set 2018

Pagine: 320 - 328

Ricevuto: 14 feb 2018

Accettato: 09 mag 2018

DOI: https://doi.org/10.2478/raon-2018-0029

© 2018 Sati Akbaba, Jan Tobias Oelmann-Avendano, Tilman Bostel, Harald Rief, Nils Henrik Nicolay, Juergen Debus, Katja Lindel, Robert Foerster, published by Sciendo

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

Figure 1

Prognostic factors for patients’ long-term quality of life (EORTC QLQ-C30, QLQ-CX24)

Quality of life of patients compared to reference populations (EORTC QLQ-C30)

Treatment and toxicity

Patients’ characteristics

Prognostic factors for survival