Risk factors of local recurrence and distant metastasis and manifestations of toxicity during chemoradiation treatment of cervical cancer patients

Abstract

Relevance. Cervical cancer remains one of the most common malignancies in women worldwide, despite declining mortality rates due to large-scale screening programs and increased use of the human papillomavirus vaccine in Western countries. Although chemoradiotherapy has been recognized as the standard therapy for patients with locally advanced carcinoma, one-third of patients experience recurrence, and the effect of its treatment is far from satisfactory. In addition, factors affecting prognosis for patients with cervical cancer remain controversial. In connection with the above, research devoted to the analysis of the long-term clinical consequences of cervical cancer treatment and the search for prognostic factors remains extremely relevant. The purpose of the work is to determine the risk factors of local and distant metastasis and manifestations of toxicity during chemoradiation treatment of cervical cancer patients. Materials and methods. Paper case histories of non-operated patients with locally disseminated сervical cancer (stages 2B–4А) who underwent special treatment in the clinic of the institute in the period 1999–2020 were selected from the archive of the State Organization «Grigoriev Institute for Medical Radiology and Oncology of the National Academy of Medical Sciences of Ukraine» for inclusion in the electronic database. The selection criterion was either a follow-up period of more than 1 year, or a tracked recurrence of the disease within a period of up to 1 year. The end of observation was considered either the death of the patient, or the appearance of oncological consequences of the disease, or withdrawal from observation for unknown reasons (censored observations). The WizWhy package of the Data Mining category was used to conduct the research and propose hypotheses, followed by hypothesis testing by non-parametric statistical methods using the STATISTICA and SPSS general-purpose software package. Non-parametric methods were used – Pearson’s chi-squared test and the Mann–Whitney U-test. Results and discussion. A number of parameters and factors that have predictive properties regarding the risk of the appearance of oncological consequences of treatment in the future have been identified. The main immediate and remote consequences of chemoradiation treatment of patients and remote somatic consequences of combined treatment were analyzed. Conclusions. Catamnetic data of «processed» case histories, provided they are processed by appropriate mathematical methods, are a potential source for obtaining new non-obvious knowledge. In particular, the correct analytical approach to the processing of formalized medical history data made it possible to find a number of risk factors for local and distant metastasis and manifestations of toxicity during chemoradiation treatment of non-operated patients with locally disseminated cervical cancer, which creates the basis for the development of proposals for adjusting antitumor therapy and individualized patient support.