Survival Impact of Prolonged Treatment Duration in Primary Chemoradiation for Cervical Cancer

Objective: Prolonged radiation treatment duration has been negatively associated with treatment outcomes in cervical cancer. We soughttoevaluate factors associated with radiation treatment duration and to analyze the impact of prolonged treatment duration on cervical cancer survival outcomes in the era of chemoradiation. Methods:Data for patients undergoing primary radiation for cervical cancer at 2 affiliated teaching institutions from 1999–2008 were retrospectively reviewed. Clinicopathologic and treatment factors were assessed for an association with treatment duration. The impact of treatment duration on disease free (DFS) and overall (OS) survival was analyzed. Results:Median treatment duration for the 129 patients who received external beam radiation therapy (EBRT) and brachytherapy was 72 days. 49 patients (38%) completed treatment within 63 days. In multivariate analysis, extent of EBRT field, timing and type of brachytherapy, treatment site and administrative delays were all predictors of treatment duration. In multivariate analysis, treatment duration greater than 63 days was associated with worse DFS (HR 2.61; 95% CI 1.22–5.56; p=0.013) and OS (HR 7.34; 95% CI 1.68–32.1; p=0.008) in early and locally advanced disease. Mortality increased by 1.3% per day for each day of prolongation of radiation duration. Conclusion:In this retrospective analysis, completion of primary chemoradiation for cervical cancer within 63 days was associated with improved DFS and OS. By focusing on potentially modifiable factors including initiation of brachytherapy during EBRT and the resolution of administrative barriers, it may be possible to improve treatment duration, which may result in better patient outcomes.