title: Distant metastasis in patients with cervical cancer after primary radiotherapy with or without chemotherapy and image guided adaptive brachytherapy.
abstract: OBJECTIVE
  The aim of this study is to investigate patterns of distant relapse after primary radiochemotherapy in cervical cancer patients.
  
  
  METHODS
  All patients with cervical cancer treated in curative intent with external beam radiotherapy +/- chemotherapy and image-guided adaptive brachytherapy between January 1998 and June 2009 at the Medical University of Vienna were included in this retrospective analysis. Patients with locoregional recurrences were excluded from this study. Presence, site of and time to distant metastases were recorded. For identifying prognostic factors, uni- and multivariate analyses using Cox regression analysis were performed. Based on the result from the multivariate analysis, patients were stratified into a high and a low risk group. The Kaplan-Meier method was used to estimate distant-metastasis-free-survival in the overall cohort, in the risk groups and for analysing the impact of chemotherapy within the risk groups.
  
  
  RESULTS
  A total number of 189 patients were included in this study. After a median follow-up of 54 months, 49 patients developed distant metastases. Overall, distant-metastasis-free-survival 5 years after treatment was 73%. FIGO stage, lymph node status and the extent of tumour regression during treatment were significant predictors for distant metastasis. Distant-metastasis-free-survival 5 years after treatment was 91% and 60% in the low and high risk groups, respectively. The number of the cycles of chemotherapy had a significant impact on the occurrence of distant metastasis in high risk patients, but not in low risk patients.
  
  
  CONCLUSIONS
  Patients with high risk factors have a 40% probability of developing distant metastasis within 5 years. In these patients, decreasing the number of cycles of cisplatin may increase their probability of developing distant metastasis.
authors: Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna, Austria. Electronic address: maximilian.schmid@akhwien.at.
authors: M P
authors: MP
authors: Schmid
authors: Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna, Austria; Department of Radiation Oncology, Erasmus Medical Center, Rotterdam, Netherlands.
authors: M
authors: M
authors: Franckena
authors: Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna, Austria; Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University of Vienna, Austria.
authors: K
authors: K
authors: Kirchheiner
authors: Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna, Austria.
authors: A
authors: A
authors: Sturdza
authors: Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna, Austria.
authors: P
authors: P
authors: Georg
authors: Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna, Austria; Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University of Vienna, Austria.
authors: W
authors: W
authors: Dörr
authors: Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna, Austria; Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University of Vienna, Austria.
authors: R
authors: R
authors: Pötter
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001918:Brachytherapy; D017024:Chemotherapy, Adjuvant; D002945:Cisplatin / Q000627:therapeutic use*; D003131:Combined Modality Therapy / Q000379:methods; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008875:Middle Aged; D015999:Multivariate Analysis; D009362:Neoplasm Metastasis; D011379:Prognosis; D016016:Proportional Hazards Models; D061089:Radiotherapy, Image-Guided; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000628:therapy*
chemical_list: D000970:Antineoplastic Agents; D002945:Cisplatin
keywords: Cervical cancer; Chemotherapy; Cisplatin; Distant metastasis; Prognostic factors; Radiotherapy