Carcinoma Cervix-Significance Of Tumour Size In Treatment Outcome

BACKGROUNDAccording to GLOBOCAN 2018, there will be an estimated 18.1 million new cancer cases and 9.6 million cancer deaths in 2018. Cancer of the cervix uteri is the fourth most frequently diagnosed cancer and fourth leading cause of cancer death in women worldwide after breast, colorectal and lung cancers. The worldwide incidence of cervical cancer is approximately 570,000 new cases annually, with approximately 311,000 deaths in 2018. More than 85% of the global burden occurs in the developing countries. In India, it is 16% of all cancers (ICMR). Many prognostic factors have been recognized in patients with cancer cervix that affects treatment outcome and causes failure. These have been divided into 1) patient related 2) tumour related and 3) treatment related factors. Patient related factors are-age, medical co-morbidities, renal status, blood haemoglobin level, HIV and HPV. Tumour related factors are-stage, lymph node involvement, parametrial extension, hydronephrosis, histology, grade and size of tumour. Treatment related factors are duration of treatment and total radiation dose and concurrent use of chemotherapy.METHODSThis is a prospective observational study. Forty patients of carcinoma cervix were analysed from July 2014 to June 2016. All patients were planned for chemoradiation followed by brachytherapy. Clinical response was assessed (as per WHO criterion) during radiotherapy and every month after radiotherapy for at least 6 months. Collected data was analysed using standard statistical methods.RESULTSIn this study, at the end of 6 months, out of a total of 40 cases studied, 75% of patients had complete response, 20% had partial response and 5% of patients had progressive disease. In this study, residual was observed in only one patient with volume of disease <4 cm (in greatest dimension). Residual was observed in only one while in patients with volume of disease >= 4 cm residual was observed in 36% of patients. This difference in volume of disease for residual is statistically significant (p=0.038).CONCLUSIONSTumour size has significant impact in treatment outcome of carcinoma cervix.