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General health status of long-term cervical cancer survivors after radiotherapy

Allgemeiner Gesundheitsstatus Langzeitüberlebender von Gebärmutterhalskrebs nach Strahlentherapie

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Abstract

Purpose

To evaluate the global health status of long-term cervical cancer survivors (LCCS) who survived for more than 4 years after curative radiation treatment (RT).

Patients and methods

Medical records of 562 women treated with RT in our institution between 2003 and 2010 were reviewed. Excluding 259 women who died of disease or were lost to follow-up, disease status and late morbidities were evaluated in 303 LCCS. Quality of life (QoL) was analyzed in 168 LCCS using a questionnaire from the European Organization for the Research and Treatment of Cancer, and the results were compared with an age-matched healthy Korean female population.

Results

Median follow-up was 6.8 years (range 4.1–12.5 years). There were 14 deaths (7 cancer specific) and 14 recurrences (5 local recurrences and 9 distant metastases). The median time to recurrence was 6.0 years (range 4.1–8.2 years). Grade ≥2 late toxicities were frequently observed in the bladder (19%) and small/large intestine (15%). Multivariate analysis revealed a higher rate of late toxicity in patients aged ≥51 years at diagnosis (small/large intestine: hazard ratio, HR, 2.5 [1.2–5.5]; bladder: HR 2.4 [1.3–4.5]; and bone: HR 4.3 [1.2–15.8]) than patients aged <51 years. Compared to the general population, LCCS exhibited a significantly higher rate of body image concerns, sexual dysfunction, lymphedema, and peripheral neuropathy.

Conclusion

New recurrences occurred in 5% of LCCS and grade ≥2 treatment-related morbidities were present in 33%. A significant proportion of LCCS also showed decreased cervical-cancer-specific QoL. These results suggest the need for long-term surveillance and follow-up care for LCCS.

Zusammenfassung

Zielsetzung

Bewertung des allgemeinen Gesundheitsstatus bei Langzeitüberlebenden von Gebärmutterhalskrebs (LCCS), die nach Strahlenbehandlung (RT) mehr als 4 Jahre lebten.

Patienten und Methoden

Überprüft wurden Krankenakten von 562 Frauen, die zwischen 2003 und 2010 in unserem Institut mit RT behandelt wurden. Ausgeschlossen wurden 259 Frauen, die aufgrund der Erkrankung verstorben sind oder deren Krankenakte verloren ging. Bewertet wurden der Erkrankungsstatus und späte Morbidität bei 303 LCCS. Die Lebensqualität (QoL) wurde bei 168 Patienten anhand des Fragebogens der europäischen Organisation für die Forschung und Behandlung von Krebs analysiert und mit gesunden altersgleichen koreanischen Frauen verglichen.

Ergebnisse

Das mediane Follow-up betrug 6,8 Jahre (Spanne 4,1–12,5 Jahre). Es gab 14 Todesfälle (7 krebsspezifische Tode) und 14 Rezidive (5 lokale Rezidive, 9 Fernmetastasen). Bis zum Rezidiv vergingen median 6,0 Jahre (Spanne 4,1–8,2 Jahre). Spättoxizität vom Grad ≥2 wurde meist in Blase (19 %) und Dünn-/Dickdarm (15 %) beobachtet. Multivariate Analysen zeigten eine hohe Rate von Spättoxizität bei Patienten >51 Jahre bei Diagnose (Dünn-/Dickdarm: Hazard Ratio [HR] 2,5 [1,2–5,5]; Blase: HR 2,4 [1,3–4,5]; Knochen: HR 4,3 [1,2–158]). Bei LCCS traten signifikant höhere Raten von Körperbildstörungen, sexuellen Störungen, Lymphödemen und peripherer Neuropathie als bei der Allgemeinbevölkerung auf.

Schlussfolgerung

Neue Rezidive kamen in 5 % der LCCS vor; behandlungsbezogene Morbidität vom Grad ≥2 hatten 33 %. Ein signifikanter Anteil von LCCS zeigte auch eine verringerte gebärmutterhalskrebsspezifische QoL. Diese Resultate sprechen für eine Langzeitüberwachung und angemessene Nachsorge bei LCCS.

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Funding

This study was supported by a National Cancer Center Grant (NCC 1611460).

Author information

Authors and Affiliations

  1. Proton Therapy Center, Research Institute and Hospital, National Cancer Center, Goyang, Korea (Republic of)

    Lee Sung Uk MD, Kim Yeon-Joo MD, Park Ji Eun BN & Kim Joo-Young MD

  2. Cancer Policy Branch, Research Institute and Hospital, National Cancer Center, Goyang, Korea (Republic of)

    Kim Young Ae PhD

  3. Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea (Republic of)

    Yoon Young-Ho MD

  4. Center for Uterine Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea (Republic of)

    Kim Yeon-Joo MD, Lim Myong Cheol MD, Park Sang-Yoon MD, Seo Sang-Soo MD & Kim Joo-Young MD

  5. Gynecologic Cancer Branch, Research Institute and Hospital, National Cancer Center, Goyang, Korea (Republic of)

    Lim Myong Cheol MD

  6. Department of Cancer Control and Policy, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea (Republic of)

    Lim Myong Cheol MD

  7. Research Institute and Hospital, National Cancer Center, 323 Ilsan-ro, 410-769, Goyang, Gyeonggi, Korea (Republic of)

    Kim Joo-Young MD

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  1. Lee Sung Uk MD
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Correspondence to Kim Joo-Young MD.

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Conflict of interest

L. Sung Uk, K. Young Ae, Y. Young-Ho, K. Yeon-Joo, L. Myong Cheol, P. Sang-Yoon, S. Sang-Soo, P. Ji Eun, and K. Joo-Young declare that they have no competing interests.

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Sung Uk, L., Young Ae, K., Young-Ho, Y. et al. General health status of long-term cervical cancer survivors after radiotherapy. Strahlenther Onkol 193, 543–551 (2017). https://doi.org/10.1007/s00066-017-1143-8

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  • DOI: https://doi.org/10.1007/s00066-017-1143-8

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