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S23
ESTRO 36
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Purpose or Objective
Advances in definitive treatment of locally advanced
cervical cancer (LACC) have increased the number of long-
time survivors and subsequently the likelihood of late and
persisting treatment-related side
effects.
Morbidity research has primarily focused on symptoms
related to organs at risk, such as bladder, bowel, rectum
or vagina. However, several patient reported outcome
studies have pointed out the substantial impact of
unspecific symptoms, such as fatigue, insomnia and hot
flashes, on patients’ quality of
life.
The purpose of this descriptive report is to evaluate the
pattern of development of these symptoms during the first
years of follow-up within the prospective, observational,
multi-center EMBRACE study (An international study on
MRI-guided brachytherapy in locally advanced cervical
cancer).
Material and Methods
From 2008-2015, 1419 LACC patients were included in the
study and treated with combined EBRT ± chemotherapy
and MRI-guided brachytherapy following the GEC-ESTRO
guidelines.
Fatigue, insomnia and hot flashes were prospectively
assessed according to CTCAE v.3 at baseline, every 3
months (1
st
year), and every 6 months (2
nd
, 3
rd
year) and
yearly thereafter. Analyses of crude incidence showing the
maximum grade over all follow-ups, prevalence rates
showing the proportion of grades in each follow-up and
actuarial probabilities (Kaplan-Meier method) were
performed.
Results
In 1176 patients from 22 centers, information on morbidity
was available at baseline and follow-up, with a median
follow-up time of 27
months.
Crude incidence rates revealed disabling G4 fatigue in two
patients. Furthermore, severe G3 morbidity occurred
rarely (all ≤ 4%). Moderate G2 morbidity was shown in 15%
(hot flashes), 11% (insomnia) and 20% (fatigue). However,
mild G1 morbidity was pronounced with 33%, 29% and 40%,
respectively. The actuarial estimates for G≥1 are
summarized in table 1 and display consistently a high risk
at 5 years for hot flashes (61.3%), insomnia (54%) and
fatigue (72.8%).
The prevalence rates revealed that both fatigue and
insomnia were already present at baseline and both
symptoms did neither resolve nor worsen over time (figure
1a and 1b). The proportion of hot flashes increased
considerably at the first follow-up after treatment and
remained quite stable over time with only a small
descriptive trend for improvement in G1 and G2.
Conclusion
Fatigue, insomnia and hot flashes are prevalent after
definitive treatment for LACC, mainly in the mild to
moderate range, and do not resolve over time. Although
both fatigue and insomnia are already present at baseline
and seem to be not influenced by treatment, more
research is needed to evaluate various risk factors in order
to define intervention strategies which are available for
hot flashes (hormonal replacement). In addition, the
impact of these symptoms on patients’ quality of life
needs to be determined in future projects, taking also
patient reported outcomes into account.
OC-0052 Physician assessed and patient reported
bladder morbidity after RCHT and IGABT for cervical
cancer
L.U. Fokdal
1
, K. Kirchheiner
2
, N. Kibsgaard Jensen
1
, J.C.
Lindegaard
1
, K. Kirisits
2
, C. Chagari
3
, U. Mahantshetty
4
,
I.M. Jürgenliemk-Schulz
5
, B. Segedin
6
, P. Hoskin
7
, R.
Pötter
2
, K. Tanderup
1
1
Aarhus University Hospital, Department of Oncology,
Aarhus C, Denmark
2
Medical University of Vienna, Department of Radiation
Oncology, Vienna, Austria
3
Gustave-Roussy, Department of Radiotherapy, Paris,
France
4
Tata Memorial Hospital, Department of Radiotherapy,
Mumbai, India
5
Utrecht University, Department of radiotherapy,
Utrecht, The Netherlands
6
Institute of Oncology Ljubljana, Department of