1- mutahir tunio

1. Five-years Outcomes of
Concurrent Chemoradiation
in Saudi Women with Locally
Advanced Cervical Cancer
Mutahir Ali Tunio, FCPS (Rad. Onc)
Radiation Oncology, Comprehensive Cancer Center
King Fahad Medical City, Riyadh

2. 0 10 20 30 40 50
Breast
Thyroid
Colorectal
NHL
Ovary
Cervix
Leukemia
Uterine
Stomach
Kidney
Skin
CNS
Hodgkin L
Others
Saudi Cancer Registry-2009 (30-44 years)
%
Background:

3. GOG-04
GOG-
85/SWOG
8695
GOG-120 GOG-165 GOG-191
Background:
RT alone Vs. RT +
Hydroxyurea
RT +
Hydroxyurea
Vs. RT + 5-
FU/cisplatin
RT +
5FU/cisplatin Vs.
RT + weekly
cisplatin Vs. RT +
Hydroxyurea
RT + weekly
cisplatin Vs.
RT + 5-FU
protracted
Randomized trials of concurrent chemo-radiation therapy for locally
advanced cervical cancer
RT + weekly
cisplatin Vs.
RT + weekly
cisplatin/EPO
Cochrane Database Syst Rev. 2014

4. Ann Saudi Med 2013; 33(4): 327-333
Aim:
To evaluate long-term
treatment outcomes and
toxicity profile of
combined Chemoradiation in
Saudi women with locally
advanced cervical cancer

5. Inclusion and Exclusion Criteria –
h/o Abdominopelvic
RT
all patients
metastatic
h/o Hysterectomy/RP
surgery
IIB-IVA; ECOG 0-2; CCRT study population
Materials and methods –
1. King Khalid
Hospital
(17.9%)
2. NGH
(30.9%)
3. King Fahad
Medical City
(51.2%)
incomplete data/Rx
IRBApproval(2007-2012)

6. Materials and methods –
Treatment and follow-up
IIIII IIIII IIIII IIIII IIIII
IIIII/
III
HDR HDR HDR
1st
yea
r
2nd
yea
r
3rd
yea
r
4th
yea
r
5th
yea
r
Follow-up
Pelvic exams; Pap
smear, Imaging
21 Gy @ 7
Gy x 3
Cisplatin 40 mg/m2
weekly
WK1 WK2 WK3 WK4 WK5 WK6-7
EBRT: 50.4 - 54.0 Gy/28-33 # HDR-BT
Weekly follow up; symptoms, weight,
pelvic exams; CBC, electrolytes,

7. RT techniques –

8. Materials and methods –
Statistical analysis
Survival probabilities were determined by Kaplan-Meier, Log rank; Student’s unpaired t test was used to
determine the difference between groups; p value <0.05 was considered significant
Endpoints
Primary: Locoregional Control
(defined as duration between the completion of CCRT and
the date of documented recurrence within irradiated fields
Secondary: Distant control; disease free
survival; overall survival and toxicity profile
Data collection
Demographics; Tumor characteristics; treatment details; Follow-up; toxicity (NCI-CTC and RTOG);
outcomes

9. Results –

10. Results –
• Median follow up duration was 5 years (range: 0.8-5.5)
• Mean duration of RT was 56 days (range:48-58)

11. Results – Toxicity

12. Results – Locoregional Failure
L1
L2
L3
L4
L5
T12

13. FOLLOW UP IN MONTHS
6050403020100
%LOCOREGIONALCONTROL
1.0
.9
.8
.7
.6
.5
.4
.3
.2
.1
0.0
Results – Locoregional Control
84.2%

14. FOLLOW UP IN MONTHS
6050403020100
%DISTANTMETASTATICCONTROL
1.0
.9
.8
.7
.6
.5
.4
.3
.2
.1
0.0
Results – Distant Metastasis Control
78.5%

15. FOLLOW UP IN MONTHS
6050403020100
%OVERALLSURVIVAL
1.0
.9
.8
.7
.6
.5
.4
.3
.2
.1
0.0
Results – Overall Survival
64.5%
(47 pts alive of analysis)

16. Subgroup No. of
Patients
Hazard Ratio
Age Age ≤ 50 years 33
Age > 50 years 41
Co-morbidities Yes 30
No 44
FIGO IIB 49
> IIB 25
Nodal disease Yes 45
No 29
Hemoglobulin < 10 gm/dL 5
> 10 gm/dL 69
Histology Adenocarcinoma/
adenosquamous
7
Squamous 67
Treatment duration < 54 days 65
> 54 days 9
Overall 74
0.0 0.5 1.0 1.5 2.0 2.5
Results –
Locoregional Control Prognostic factors

17. Discussion – Merits
2
3
4
Good sample size1
Long follow-up duration
Moderate doses of weekly cisplatin
Better RT techniques
5 Multidisciplinary approach

18. Discussion – Limitations
2
3
4
Retrospective1
Sampling bias
Majority of Cohort with DM and HTN
Lead time bias
5 Lack of data on QoL

19. Outcomes in
agreement
with
international
data
Further results
of IMRT are
warranted
Multidisciplinary
approach
High No:
DM and HTN warrants
public awareness
Conclusions –
LARC warrants
screening
campaign in the
Kingdom

20. Acknowledgement
• Dr. Mushabbab AlAsiri, for his constant support and encouraging for
this research
• Dr. Yasser Bayoumi, Dr. Abdulrehman AlHadab, Dr. Eyad AlSaeed, Dr.
A. Amro, Mohannad Arifi (Student KSU), Radiation Oncology-KFMC,
Gynecology Oncology team-KFMC and our patients for giving us
opportunity to present this study in front of you
• Scientific Chair of Prof. Abdullah Hussain Basalamah for GYN Cancer;
for giving the platform to present this study

21. Thank you ??