926P - Impact of demographic characteristics, staging methods and treatment in a European Locally advanced Cervical Cancer (LACC) population

Date 27 September 2014
Event ESMO 2014
Session Poster Display session
Topics Cervical Cancer
Cancer Aetiology, Epidemiology, Prevention
Imaging, Diagnosis and Staging
Presenter Enrique Sanz-Garcia
Citation Annals of Oncology (2014) 25 (suppl_4): iv305-iv326. 10.1093/annonc/mdu338
Authors E. Sanz-Garcia1, M. Gil-Martin2, C. Linossi1, X. Perez-Martin3, L. Fariñas-Madrid1, S. Marin I Borras4, R. Verges5, A. Gil6, J. Ponce Sebastia7, V. Rodriguez-Freixinos1, J.M. Del Campo1, X. Garcia Del Muro2, B. Pardo Búrdalo8, A. Oaknin9
  • 1Medical Oncology, Vall d' Hebron University Hospital, 08035 - Barcelona/ES
  • 2Medical Oncology, Institut Català d'Oncologia-IDIBELL, 08907 - L'Hospitalet , Barcelona/ES
  • 3Clinical Investigation Unit, Institut Català d'Oncologia-IDIBELL, 08907 - L'Hospitalet , Barcelona/ES
  • 4Radiation Oncology, Institut Català d'Oncologia-IDIBELL, 08907 - L'Hospitalet , Barcelona/ES
  • 5Radiation Oncology, Vall d' Hebron University Hospital, 08035 - Barcelona/ES
  • 6Gynaecologic Department, Vall d' Hebron University Hospital, 08035 - Barcelona/ES
  • 7Gynecology, Hospital Universitario de Bellvitge, 08907 - L'Hospitalet , Barcelona/ES
  • 8Medical Oncology, Institut Català d'Oncologia, 08907 - L'Hospitalet , Barcelona/ES
  • 9Medical Oncology, Vall d 'Hebron University Hospital Institut d'Oncologia, 08035 - Barcelona/ES

Abstract

Aim

FIGO defines Cervical Cancer staging but in developed countries Pelvic MRI, PET/CT and surgical staging (SxS) are widely used. LACC standard of care is chemoradiotherapy (CTRT). Besides FIGO stage and Lymph nodes (LN) status, other prognostic factors (PF) are trying to be identified.

Methods

Between May 2008 and November 2013, 148 consecutive LACC patients (pts) treated homogenously with CTRT from 2 Spanish academic Institutions were collected. Demographic, social, clinical characteristics and staging methods were analyzed and correlated with clinical outcomes.

Results

Median age at diagnosis was 51.8 years (23-82.5) and PS 0-1(98%). Sixty-five percent had not followed screening program, 55% had a postmenopausal status, 58% never smokers. Median time from first symptom to diagnosis was 2.9 months (0- 58.3). Squamous cell 79.1%; G3 36.3%; High risk HPV 91.8%. FIGO Stage: IB2 8.8%; IIA 10.8%; IIB 48%; IIIB 17.6%; IVA 4.1% . MRI, PET/CT or both were performed in 95.3%, 51.7%, and 48.6% respectively. Clinical and MRI Stage correlation was: IB2 30.8%; IIB 76.1%; IIIB 19.2% and IVA 83.3%. Para-Aortic (PA) LN were studied by PET/CT, SxS and both in 51.7%, 50.7% and 33.1% respectively. In the combined group, negative PA LN were: 91.8% by PET/CT and 87.8% by SxS, showing a PET/CT specificity of 93%. All pts received Pelvic EBRT (median 45Gy) through 3D (81.8%) and IMRT (18.2%) concurrent with 6 weekly cisplatin (1-7). PA field and parametrial boost was added in 23% and 53.4% respectively. PDR Brachytherapy was delivered in 79.1%. Planned treatment was completed in 74.3%; median duration 8.5 weeks (3.8-18.8). Median follow-up was 22.4 months (2.3-61.2). RFS and OS at 2 years: 71.4%; 95%IC (63.4%-79%) and 80.7%; 95%IC (73.6%-88%) respectively. In univariate analysis OS main PF was FIGO Stage: IB2 92,3%, IIA 87.5%, IIB 81.7%, IIIB 65.4%, IVA 66.7%. Smoking does not impact in OS; oral anticonception and pre-menopausal status showed a trend to worse OS.

Conclusions

CTRT is still an insufficient treatment in LACC. FIGO Staging might be improved adding imaging tests. PA Lymph nodes diagnostic method is still matter of controversy; our PET/CT data are according to literature. Neither social nor demographic characteristics were identified as PF.

Disclosure

All authors have declared no conflicts of interest.