923P - Impact of computed tomography on treatment modification and survival in cervical cancer patients

Date 27 September 2014
Event ESMO 2014
Session Poster Display session
Topics Cervical Cancer
Imaging, Diagnosis and Staging
Presenter Achiraya Teyateeti
Citation Annals of Oncology (2014) 25 (suppl_4): iv305-iv326. 10.1093/annonc/mdu338
Authors A. Teyateeti, N. Apiwarodom
  • Radiology , Division Of Radiation Oncology, Faculty of Medicine , Siriraj Hospital , Mahidol University, 10700 - Bangkok/TH

Abstract

Aim

Findings of lymph node and distant metastases from pretreatment computed tomography (CT) may lead to treatment modifications. However, survival benefit from the modification remains unclear.

Methods

Medical records of 457 patients with clinical stage IB2 to IVA cervical cancer from January 2007 to December 2009 were retrospectively reviewed and stratified into CT and no CT group. Patients in CT group with negative imaging (no lymph node and distant metastases) and patients in no CT group received standard whole pelvic radiation (RT) with or without weekly platinum-based chemotherapy (CMT). Patients in CT group with positive imaging (lymph node and/or distant metastases) might individually receive modified RT (adjusted field edge, added para-aortic lymph node RT, added boost field and changed in RT dose), modified CMT (changed in CMT regimen and/or added adjuvant CMT) or combined modification. Survival analysis was done according to initial FIGO clinical staging.

Results

Of 242 patients in CT group and 215 patients in no CT group, stage I to IV disease were 1.7%, 38.4%, 58.7%,1.2% and 5.6%, 46%, 47%, 1.4%, respectively. Pretreatment imaging found lymph node and/or distant metastases in 43.4% and upstaged in 27.6% of patients, according to the 7th AJCC system. Treatment modifications were elicited in 21.9% of patients; RT (13.2%), CMT (4.1%) and both (4.5%). At median follow-up time of 35 months, progression-free survival (PFS) and overall survival (OS) at 3 years in CT and no CT group were 70.1% vs 74.7% (p = 0.135) and 68.3% vs 76.4% (p = 0.016). Subgroup analysis by stage showed that patients with stage II disease in CT and no CT group had no significant difference in 3-year PFS and OS; 80.3% vs 83.3% (p = 0.673) and 81.3% vs 79.7% (p = 0.802), respectively. In stage III disease, patients in both groups had no significant difference in 3-year PFS, 64.1% in CT group and 68.4% in no CT group (p = 0.187). However, the 3-year OS was significantly worse in CT group, 59.0% vs 72.8% (p = 0.023).

Conclusions

Although pretreatment imaging can lead to more accurate staging and treatment modification, not all patients would benefit from the current treatment modification.

Disclosure

All authors have declared no conflicts of interest.