| Sažetak | Objectives: This study aimed to evaluate survival and recurrence data as well as the QoL data in cervical cancer patients following radiochemotherapy (RCT) and brachytherapy as definitive treatment. The goal was to identify factors that can be modified to enhance overall survival and QoL for these patients.
Materials and methods: Between 2003 and 2023, a total of 132 patients with advanced cervical cancer were evaluated for possible treatment at the Coburg Cancer Center. For this retrospective analysis, 81 patients were excluded due to various reasons (post-operative RCT, radiotherapy without brachytherapy, neoadjuvant RCT, palliative RCT, treatment of cancer recurrence, simultaneous treatment of other malignancy). Thus, 51 patients were included in this study. Analysis of patient data was primarily focused on age at initial diagnosis, menstrual status, FIGO stage, histology, overall survival, remission, occurrence of distant metastases or pelvic recurrence, total dose of radiation, brachytherapy, and concurrent chemotherapy, and occurrence of acute or late toxicities. Additionally, QoL was assessed prospectively by patient self-completion of the EORTC-QLQ-C30 and EORTC-QLQ-CX24.
For the analysis of the statistical data IMB SPSS Statistics 29 for macOS (IBM Corp, 2022) was used. Survival rates were calculated by the Kaplan-Meier method, and the log-rank test was used to compare survival rates between different groups of patients. Qualitative data were expressed as whole numbers and percentages, while quantitative data were expressed as mean ± standard deviation or mean and interquartile range. For analysis of the EORTC questionnaires, all data were summarized in descriptive statistics. To compare differences between two groups, the t-test was performed. The chi-square test was applied to compare two categorical variables, and regression analysis was used to examine the influence of certain variables on QoL.
Results: 5-year overall survival, NED-survival, and pelvic-recurrence-free survival rates were 48±9%, 68±14% and 52±10%, respectively. A significant impact on 5-year overall survival rates was seen for FIGO-stage (IIA-IIIA: 74±13% vs IIIB-IVA: 29±12%, p=0.027) for distant metastases (W/o DM: 75±12% vs with DM: 25±11%, p=0.05). Neither development of pelvic recurrence nor histology had significant impact survival rates.
QoL-questionnaire evaluation resulted in a score of 63/100 for the overall QoL of patients. Cognitive function was the least impaired with a score of 84, while role functioning was the worst with a score of 67. On the symptom scale, Insomnia (46/100), Fatigue (41/100), Dyspnea (32/100), and Pain (26/100) scored the worst. Financial difficulties also burdened some patients and achieved a score of 25/100. Diarrhea, constipation, appetite loss, and nausea/vomiting were rated as less distressing by patients. The cervical cancer-specific questions of the EORTC-QLQ-CX24 questionnaire revealed that peripheral neuropathy, score of 36/100, and lymphedema, score of 32/100, occurred most frequently. Patients also reported that their sexual/vaginal functioning was impaired (32/100) and that their own body image (22/100) was also affected. The functional sexual activity scale could only be completed by 5 patients who had been sexually active in the last four weeks. This showed that only one third of them could enjoy sex. Comparing the result of evaluation of the EORTC-questionnaires showed no significant differences in the QoL of patients above and under the age of 58 years, and there was also no difference seen in patients diagnosed with FIGO stage <IIIB and ≥IIIB. However, there was a tendency for QoL to be less limited at an earlier stage of diagnosis.
Conclusion:
In patients with advanced inoperable cervical carcinoma a combination of radiochemotherapy and brachytherapy is able to cure around 50% of the patients. Advanced stages IIIB and IVA according to FIGO and the development of distant metastases have a significantly negative impact on outcome. In terms of patient reported long-term quality of life specific support is needed to alleviate symptoms including lymphedema, peripheral neuropathy, and impaired sexual activity. |
| Sažetak (hrvatski) | Ciljevi: Ova studija imala je za cilj procijeniti podatke o preživljenju i recidivu, kao i podatke
o kvaliteti života kod pacijenata s rakom vrata maternice nakon radiokemoterapije (RCT) i
brahiterapije kao konačnog liječenja. Cilj je bio identificirati čimbenike koji se mogu
modificirati kako bi se poboljšalo ukupno preživljenje i QoL za ove pacijente.
Materijali i metode: Između 2003. i 2023. ukupno 132 pacijentice s uznapredovalim rakom
vrata maternice procijenjene su za moguće liječenje u Centru za rak u Coburgu. Za ovu
retrospektivnu analizu isključen je 81 pacijent zbog različitih razloga (postoperativni RCT,
radioterapija bez brahiterapije, neoadjuvantni RCT, palijativni RCT, liječenje recidiva raka,
istovremeno liječenje drugih malignih bolesti). Tako je u ovo istraživanje bio uključen 51
pacijent. Analiza podataka pacijenata prvenstveno je bila usmjerena na dob pri početnoj
dijagnozi, menstrualni status, stadij FIGO, histologiju, ukupno preživljenje, remisiju, pojavu
udaljenih metastaza ili recidiva u zdjelici, ukupnu dozu zračenja, brahiterapiju i istodobnu
kemoterapiju te pojavu akutne ili kasne toksičnosti. Dodatno, QoL je procijenjen prospektivno
samoispunjavanjem EORTC-QLQ-C30 i EORTC-QLQ-CX24 pacijenta.
Za analizu statističkih podataka korišten je IMB SPSS Statistics 29 za macOS (IBM Corp,
2022.). Stope preživljenja izračunate su Kaplan-Meier metodom, a log-rank test korišten je za
usporedbu stopa preživljenja između različitih skupina bolesnika. Kvalitativni podaci izraženi
su kao cijeli brojevi i postoci, dok su kvantitativni podaci izraženi kao srednja vrijednost ±
standardna devijacija ili srednja vrijednost i interkvartilni raspon. Za analizu EORTC upitnika
svi podaci su sažeti u deskriptivnu statistiku. Za usporedbu razlika između dviju skupina
proveden je t-test. Hi-kvadrat test primijenjen je za usporedbu dviju kategoričkih varijabli, a
regresijskom analizom ispitan je utjecaj pojedinih varijabli na QoL.
Rezultati: Stope 5-godišnjeg ukupnog preživljenja, NED-preživljenja i stope preživljenja bez
recidiva u zdjelici bile su 48±9%, 68±14% odnosno 52±10%. Značajan utjecaj na petogodišnje
ukupne stope preživljenja primijećen je za stadij FIGO (IIA-IIIA: 74±13% u odnosu na IIIBIVA: 29±12%, p=0,027) za udaljene metastaze (bez DM: 75± 12% u odnosu na DM: 25±11%,
p=0,05). Niti razvoj recidiva u zdjelici niti histologija nisu značajno utjecali na stope
preživljavanja.
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Procjena QoL-upitnika rezultirala je rezultatom od 63/100 za ukupni QoL pacijenata. Najmanje
je oštećena kognitivna funkcija s ocjenom 84, dok je funkcioniranje uloga najlošije s ocjenom
67. Na ljestvici simptoma nesanica (46/100), umor (41/100), dispneja (32/100), i Bol (26/100)
je dobio najlošiju ocjenu. Financijske poteškoće također su opteretile neke pacijente te su
postigle ocjenu 25/100. Pacijenti su proljev, zatvor, gubitak apetita i mučninu/povraćanje
ocijenili kao manje uznemirujuće. Pitanja specifična za rak vrata maternice iz upitnika EORTCQLQ-CX24 otkrila su da su se najčešće javljali periferna neuropatija, rezultat 36/100, i
limfedem, rezultat 32/100. Pacijenti su također izjavili da je njihova spolna/vaginalna funkcija
bila oslabljena (32/100) te da je također bila pogođena slika vlastitog tijela (22/100). Ljestvicu
funkcionalne seksualne aktivnosti moglo je ispuniti samo 5 pacijenata koji su bili spolno aktivni
u posljednja četiri tjedna. To je pokazalo da samo jedna trećina njih može uživati u seksu.
Usporedba rezultata evaluacije EORTC-upitnika nije pokazala značajne razlike u QoL
bolesnika starijih i mlađih od 58 godina, a također nije bilo razlike uočenih u bolesnika s
dijagnosticiranim FIGO stadijem <IIIB i ≥IIIB. Međutim, postojala je tendencija da QoL bude
manje ograničen u ranijoj fazi dijagnoze.
Zaključak: U bolesnika s uznapredovalim inoperabilnim karcinomom vrata maternice
kombinacija radiokemoterapije i brahiterapije može izliječiti oko 50% bolesnika.
Uznapredovali stadiji IIIB i IVA prema FIGO te razvoj udaljenih metastaza imaju značajno
negativan utjecaj na ishod. Što se tiče dugotrajne kvalitete života koju su pacijenti prijavili,
potrebna je posebna podrška za ublažavanje simptoma uključujući limfedem, perifernu
neuropatiju i oslabljenu seksualnu aktivnost. |
