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KMID : 1143220220650020176
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Obstetrics & Gynecology Science
2022 Volume.65 No. 2 p.176 ~ p.187
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Impact of hematologic toxicities during concurrent chemoradiation for cervical cancer
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Shi Feiya
Yoder Alison K.
Mach Claire
Dalwadi Shraddha
Anderson Matthew L.
Hall Tracilyn R.
Ludwig Michelle S.
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Abstract
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Objective: To evaluate the prognostic significance of hematological toxicities during cervical cancer treatment.
Methods: Patients treated for cervical carcinoma with definitive chemoradiation were identified. Toxicities were assessed during weeks 1 to 6 of concurrent external beam radiation and chemotherapy. Outcomes were analyzed using Cox regression analysis.
Results: One hundred twenty-one patients with Federation of Gynecology and Obstetrics stage I-III disease were eligible for analysis. Median age at diagnosis was 45 years (interquartile range, 40-52) with median follow-up time of 34 months (95% confidence interval, 30.8-37.2). All patients experienced some grade of hematologic toxicity. The most common grade 3+ toxicities were low absolute lymphocyte count (n=115, 95%), low white blood cell count (n=21, 17%), and anemia (n=11, 9%). The most common grade 4 toxicity was lymphopenia, experienced by 36% of patients (n=44). Grade 4 lymphopenia was associated with reduced overall survival (hazard ratio [HR], 4.5; P=0.005), progression-free survival (HR, 3.4; P=0.001), and local control (HR, 4.1; P=0.047). Anemia grade 3, 4 was also associated with reduced overall survival (HR, 4.1; P=0.014). After controlling for disease and treatment variables, grade 4 lymphopenia remained significantly associated with reduced overall survival (HR, 9.85; P=0.007). The association with grade 4 lymphopenia only remained significant in women of Hispanic ethnicity.
Conclusion: Severe lymphopenia was associated with reduced overall survival and progression-free survival in Hispanic women undergoing definitive chemoradiation for cervical cancer, but not associated with outcomes in non-Hispanic women.
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KEYWORD
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Uterine cervical neoplasms, Chemoradiotherapy, Anemia, Lymphopenia
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