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Cervical cancer radiation therapy compliance rates based on location of radiation therapy
Corinne Calo , John O. Elliott, Aine Clements, Gary Reid, Kellie Rath
Ohio Heath Gynecologic Cancer Surgeons, Riverside Methodist Hospital, Medical Education, United States of America
• Patients who underwent portions of their radiation therapy at different locations had protracted treatment courses.
• Patients who underwent all of their RT at one location finished their therapy an average of 16.4 days sooner.
• Patients with prolonged treatment courses who underwent RT at multiple locations had poorer overall survival.
Objective. Completion of radiation therapy (RT) within 60 days has been proposed as a national quality mea-sure for patients with carcinoma of the 39800-16-3 as protracted RT has been associated with worse oncologic out-comes. The objective of this study was to compare compliance rates based on location of RT administration. Methods. This was a retrospective chart review of patients diagnosed with cervical cancer between January of 2000 to December of 2016 who were planned to undergo primary treatment with sensitizing chemotherapy and RT. Patients who completed both external beam radiation therapy (EBRT) and brachytherapy (BT) at the primary institution were compared to patients who completed a portion or all of their RT elsewhere. The primary out-come measured was completion of RT within 60 days. Secondary outcomes included compliance with sensitizing chemotherapy, total radiation dose, recurrence rate, progression free survival (PFS) and overall survival (OS). The groups were compared using standard statistical analysis.
Results. This study included 100 patients, 75 of which received all of their RT at the primary institution. These patients were more likely to complete RT within 60 days when compared to patients who underwent RT at dif-ferent facilities (58.7% vs 24%, respectively; p = 0.005). Patients who underwent all of their RT at the primary in-stitution completed their therapy an average of 16.4 days sooner (75.1 ± 21.3 days versus 58.7 ± 13.2 days; p = 0.001). Overall survival was significantly improved in this group (p = 0.03). Conclusion. Women who complete EBRT and BT at different institutions are more likely to have a protracted RT course (N60 days). These patients should be identified at diagnosis and efforts made to coordinate their care to avoid delays in treatment.
The current treatment for locally advanced cervical cancer (Stage IB1-IVA) involves curative external beam radiation therapy (EBRT) with concurrent chemotherapy, followed by intracavitary brachyther-apy (BT). Higher survival rates and local control are achieved when sev-eral quality indicators are applied. These quality indicators are endorsed by the Society of Gynecologic Oncology (SGO). The mainstay of these quality indicators include adequate radiation tumor dose and volume
Corresponding author at: 3535 Olentangy River Rd, Columbus, OH 43214, United States of America.
E-mail address: [email protected] (C. Calo).
[1–3], limitation of overall treatment time to less than approximately 56–60 days [2,4,5], the use of brachytherapy [5,6], and administration of concurrent chemotherapy [5,7]. It has been demonstrated that pa-tients treated according to specific clinical practice guidelines, regard-less of stage, have a higher cancer-specific survival after five years when compared to nonadherence to these guidelines (88% vs 56%; P b 0.001) .