Obstet Gynecol Sci.  2022 Mar;65(2):176-187. 10.5468/ogs.21308.

Impact of hematologic toxicities during concurrent chemoradiation for cervical cancer

• Shi F
• Yoder AK
• Mach C
• Dalwadi S
• Anderson ML
• Hall TR
• Ludwig MS

• KMID: 2527269
• DOI: http://doi.org/10.5468/ogs.21308

Abstract

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.

Keyword

Uterine cervical neoplasms; Chemoradiotherapy; Anemia; Lymphopenia

Figure

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  Fig. 1 Hematologic toxicity at nadir during concurrent chemoradiation. WBC, white blood cell; Hg, hemoglobin; ANC, absolute neutrophil count; ALC, absolute lymphocyte count.

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  Fig. 2 Kaplan-Meier curve showing OS, PFS, and LC for patients with grade 4 lymphopenia compared to all other patients (A–C), and OS and PFS for patients with grades 3 to 4 anemia compared to those with grades 0 to 2 anemia (D, E). OS, overall survival; PFS, progression-free survival; LC, local control.

Reference

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