Treatment Interruption During Concurrent Chemoradiotherapy of Uterine Cervical Cancer; Analysis of Factors and Outcomes

Background: To evaluate factors which effect treatment interruption during concurrent chemoradiotherapy (CCRT) and overall survival in patients with uterine cervical cancer stage IB2-IVA in Srinagarind Hospital. Materials and Methods: Between January 2006 and December 2007, 107 patients with stage IB2-IVA as FIGO staging, 2000, were treated with CCRT in Srinagarind Hospital. Factors which caused treatment interruptions and impacted on overall survival were reviewed and analyzed. Results: Twenty of 107 patients had treatment interruption during CCRT in patients with uterine cervical cancer stage IB2-IVA in Srinagarind Hospital. The causes of treatment interruption were as follows: hematologic toxicity was found in 16 of 20 cases, 12 cases with grade 2 and 4 cases with grade 3; three of 20 cases had gastrointestinal toxicities, 1 case with grade 2 and 2 cases with grade 3; one case had grade 3 skin toxicity. The mean total treatment time of the uninterrupted and interrupted groups were significantly different (78.98 days vs 161.80 days, p <0.001). The patients who could tolerate ${\geq}5$ cycles of cisplatin administration had significantly higher mean white blood counts (WBC) ($9,769cells/mm^3$ vs $7,141cells/mm^3$, p=0.02). The mean initial hemoglobin (Hb) in the uninterrupted group was significantly higher than the interrupted group (11.5 mg% vs 10.3 mg%, p=0.03). Other factors including age, KPS, initial platelets, initial serum creatinine levels showed no statistical significance. The 3-year overall survival of the uninterrupted group was better than in the interrupted group (78.6% vs 55.0%, p=0.03). Conclusions: The initial Hb and WBC levels were significantly correlated with treatment interruption during CCRT in patients with uterine cervical cancer. The 3-year overall survival of the uninterrupted group was significantly better than interrupted group. These factors may then be used indirectly to predict the outcomes of treatment.