Abstract

Martina Ferioli^1,2, Andrea Galuppi¹, Milly Buwenge^1,2, Anna Myriam Perrone³, Francesco Deodato^4,5, Alessia Re⁶, Savino Cilla⁷, Elisa Deraco^1,8, Erika Galietta^1,2, Nataliya Razganiayeva¹, Nataliya Razganiayeva², Michela Boriani¹, Silvia Cammelli^1,2, Pierandrea De Iaco^3,9, Alessio Giuseppe Morganti^10,11, Gabriella Macchia⁶

¹Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; ²Department of Experimental, Diagnostic and Specialty Medicine – DIMES, Alma Mater Studiorum Bologna University, Bologna, Italy; ³Division of Oncologic Gynaecology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; ⁴ Radiation Oncology Unit, Gemelli Molise Hospital – Università Cattolica del Sacro Cuore, Campobasso, Italy; ⁵Istituto di Radiologia, Università Cattolica del Sacro Cuore, Roma, Italy; ⁶Radiation Oncology Unit, Gemelli Molise Hospital – Università Cattolica del Sacro Cuore, Campobasso, Italy; ⁷Medical Physic Unit, Gemelli Molise Hospital – Università Cattolica del Sacro Cuore, Campobasso, Italy; ⁸Department of Experimental, Diagnostic and Specialty Medicine – DIMES, Alma Mater Studiorum Bologna University , Bologna, Italy; ⁹Oncologic Gynaecology Unit, Department Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy; ¹⁰Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; ¹¹Department of Experimental, Diagnostic and Specialty Medicine – DIMES , Alma Mater Studiorum Bologna University, Bologna, Italy

Previous studies have shown that patients with cervical cancer undergoing pelvic chemoradiation followed by brachytherapy (CRT/BT) or radical surgery (CRT/RS) have similar outcomes. However, data on any differences in Quality of Life (QoL) are lacking. Aim of this analysis is to compare long term QoL in two groups of locally advanced cervical cancer patients treated with CRT/BT or CRT/SUR.

Patients who underwent pelvic CRT/BT or CRT/RS in two radiotherapy departments and with a follow-up ranging from two to five years were enrolled in a questionnaire-based study. QoL and bladder, intestinal, and sexual function was evaluated with the Functional Assessment of Cancer Therapy-Cervix (FACT-Cx) including the Functional Assessment of Cancer Therapy (FACT-G), a cervix cancer-specific subscale (CxCS), and the Trial Outcome Index (TOI).

Fifty patients (25 treated with CRT/BT and 25 with CRT/RS) were enrolled and filled out the 42-items questionnaire. Median age was 55 and 47 years in CRT/BT and CRT/RS, respectively. Most patients had stage IIB disease in both groups (76% and 72%, respectively). The only two statistically significant differences between groups were median radiotherapy (RT) dose (46 and 45 Gy, respectively) and main RT technique (3D-conformal RT and Intensity modulated RT, respectively). Significant differences in favour of CRT/RS were found in: i) CxCS scores concerning morbidity and adverse events from treatments (p = 0.004); ii)  FACT-Cx TOI scores concerning physical/functional outcomes (p = 0.017); iii) FACT-Cx total score (p = 0.035). CRT/SUR scores were better, in the item- by- item comparison, in terms of: nausea, feeling bad, closeness to partner, sleep, vaginal discharge, fear of treatments, and appetite. Instead, no significant differences between CRT/BT and CRT/RS were found about sexual function.

Better QoL scores, measured by FACT-Cx questionnaire, at least two years after treatment, were recorded in CRT/RS compared with CRT/BT patients with locally advanced cervical cancer. Prospective studies are needed to confirm these results.