ANALYSIS OF TREATMENT OUTCOMES IN LOCALLY ADVANCED CERVICAL CARCINOMA - AN INSTITUTIONAL STUDY

Introduction:Carcinoma cervix is the second most common cancer among women in India. Carcinoma cervix is associated with many risk factors such as multi parity, early age at marriage, early age at coitus and the most important basic cause is poor socioeconomic status, illiteracy, lack of proper self-hygiene, lack of awareness of screening programs and treatment modalities. The main objective of this study is to analyze various outcomes following treatment of locally advanced carcinoma cervix and also to determine the causes of treatment failure so as to improve disease free survival, progression free survival and overall survival. Materials And Methods: A retrospective study was conducted among 191 locally advanced cervical carcinoma patients treated in the Department of Radiotherapy, Stanley Medical College and Hospital, Chennai during the period between 2015 and 2019. Various parameters of our study included age distribution, chief complaints at presentation, histopathological types and grades, staging, type of treatment, details of brachytherapy, response assessment and follow up. Results: Majority of them belong to stage II(50%) followed by stage III (41%). 14 patients belong to stage IV and only 4 patients belong to stage I. Among them 102 patients (53.4%) showed complete response and 34 patients (17.8%) showed partial response. Discussion: Most of the patients were in 4th and 5th decade which is very close to TNCRPregistry. Stage grouping of patients is considered most signicant in assessing the outcome of the treatment wherein it was found necessary to identify and present the symptoms at early stage to fasten the treatment and aim at complete cure. Conclusion: This study brings a clear picture of the possible reasons for treatment failure in locally advanced cervical carcinoma and highlights necessary steps to be implemented in improving infrastructure facilities in Government hospitals that would result in better treatment for poor patients with maximum benets.

What to do when nothing else is left to be done - metastatic non-HPV vulvar squamous cell carcinoma with multiple lines of chemotherapy

Recurrent vulvar squamous cell carcinoma with multiple site metastases is a rare entity – (up to 14.2% of the total number of recurrences), with a poor prognosis (only 15% of the patients alive at 5 years). Due to its “hard to find” character, there are no standardized guidelines available and the treatment is extrapolated from advanced cervical carcinoma, anal carcinoma and other squamous cell carcinomas. Immunotherapy has shown some positive results in vulvar carcinoma with PD-L1 positive, high TMB, high MSI or with MMR deficiency. An alternative for selected cases without therapeutic resources could be the HPV vaccine. We present the case of a 64-year-old woman diagnosed in 2014 with vulvar squamous cell carcinoma stage II for which she underwent radical vulvectomy with bilateral inguinal lymphadenectomy followed by external radiotherapy. In 2019 she developed local recurrence associated with lung, pleural, lymph nodes and subcutaneous metastasis, treated with three lines of chemotherapy: paclitaxel/carboplatin followed by cisplatin/5-fluorouracil and carboplatin/gemcitabine. The patient’s general health status altered progressively, and she died after the 4th cycle of carboplatin/gemcitabine. This case’s management could be a starting point for the vulvar carcinoma cases where the standard therapeutical options do not represent a choice anymore, providing the necessary example on how to approach it.

Neoadjuvant Chemotherapy Followed by Surgery/Chemoradiotherapy Versus Radical Chemoradiotherapy in Stage IB2, IIA2, IIB Locally Advanced Cervical Carcinoma: A Retrospective Multicenter Study of 388 Patients

Purpose: The present study aimed to compare the oncologic outcomes and side effects between neoadjuvant chemotherapy followed by surgery/chemoradiotherapy and radical chemoradiotherapy for locally advanced cervical carcinoma (LACC).Methods: We conducted a retrospective review of patients with LACC (IB2, IIA2 and IIB stages) from six hospitals between June 2007 and January 2017. Results: A total of 388 patients were included, in which 278 patients received radical chemoradiotherapy (Standard group), and 110 patients received neoadjuvant chemotherapy. 65 patients of the 110 received radical hysterectomy (Surgery group), and 45 received chemoradiotherapy (Neo-Ra group). The 5-year overall survival (OS) in Surgery group (92.5%) was similar to that of the Standard group (84.9%), but both groups had higher OS rates than Neo-Ra group (75.6%). The 5-year disease-free survival (DFS) and progression-free survival (PFS) showed no differences among the three groups, respectively. There were no significant differences for grades 1-3 gastrointestinal and genitourinary toxicities among the three groups. No patient had grade 4 adverse effects. In multivariate analysis, tumor regression (CR vs. PR+SD+PD), pathological type (squamous cancer vs. non-squamous cancer) and lymph node metastasis (positive vs. negative) were considered as independent predictors of OS. Furthermore, besides above factors, the maximum diameter of tumors and adjuvant chemotherapy were also considered as significant prognostic factors for DFS and PFS.Conclusion: These findings showed that neoadjuvant chemotherapy followed by radical hysterectomy as a feasible and reliable therapy, resulting in encouraging oncologic outcomes and low side effects when compared to those obtained by standard chemoradiotherapy for IB2, IIA2, IIB stage cervical carcinoma patients.

Tumor Histology is an Independent Prognostic Factor in Locally Advanced Cervical Carcinoma. A Retrospective Study

Background: Even with different histologic origins, squamous cell carcinoma (SCC) and adenocarcinoma (AC) are considered a single entity, and the first-line treatment is the same. Locally advanced disease at the diagnosis of cervical cancer is the most important prognostic factor, the recurrence rate is high, making it necessary to evaluate prognostic factors other than clinical or radiological staging; histology could be one of them but continues to be controversial. The aim of this study was to evaluate tumor histology as a prognostic factor in terms of treatment outcomes, disease-free survival (DFS) and overall survival (OS) in a retrospective cohort of patients with Locally Advanced Cervical Carcinoma (LACC). Methods: The records of 1291patients with LACC were reviewed, all of them were treated with 45-50 Gy of external bean radiotherapy with concurrent chemotherapy and brachytherapy. A descriptive and comparative analysis was conducted. Treatment response was analyzed by the chi-square test; DFS and OS were calculated for each histology with the Kaplan-Meier method and compared with the log-rank test; and the Cox model was applied for the multivariate analysis. Results: We included 1291 patients with LACC treated from 2005 to 2014, of which 1154 (89·4%) had SCC and 137 (10·6%) had AC. Complete response to treatment was achieved in 933 (80·8%) patients with SCC and 113 (82·5%) patients with AC. Recurrence of the disease was reported in 29·9% of SCC patients and 31·9% of AC patients. Five-year DFS was 70% for SCC and 62·2% for AC. The five-year OS rates were 74·3% and 60% for SCC and AC, respectively. The mean DFS was 48·8 months for SCC vs 46·10 for AC (p=0·043), the mean OS was 50·8 for SCC and 47·0 for AC (p=0·002).Conclusion: Our findings support the hypothesis that SCC and AC are different clinical entities. Trial Registration: NCT04537273