Para-Aortic Nodal Involvement: A Significant Determinant of Treatment-Related Toxicity in Cervical Cancer Patients

Cervical cancer treatment is associated with significant early and late treatment-related toxicity. Understanding the treatment-related factors that contribute to higher toxicity is key to improving patient outcomes and long-term quality of life. Data from 435 patients with carcinoma of the cervix who received radical treatment were retrieved from the hospital records of a tertiary care cancer center. The required information was extracted and recorded in predesigned study proformas. The data were analyzed using Stata IC Software version 15. Pearson's Chi-square and Fisher's Exact tests were used for univariate association analysis. Multivariate logistic regression was employed to adjust for confounders and identify the associations between various risk factors and toxicities.

Sixty-three patients (14.4%) experienced any grade of acute treatment-related toxicity. Hematological toxicity was the most common, affecting 36 patients (57.1%), followed by dermal toxicities in 15 patients (23.8%) and gastrointestinal toxicities in 11 patients (17.5%). One patient (1.6%) experienced mucosal toxicity. Univariate and multivariate analyses revealed that only para-aortic nodal involvement was significantly associated with an increase in both acute and late treatment-related toxicities (P = 0.006). Other factors, such as age, hemoglobin levels, stage, previous surgery, parametrial bulk, extension to the pelvic side-wall, and dose to point A, did not significantly affect the overall incidence of toxicity. The number of chemotherapy cycles <4 was also associated with higher acute toxicity (P = 0.031). Para-aortic nodal involvement was significant for both acute and late treatment-related toxicities. The use of modern conformal radiotherapy techniques in these patients may help reduce treatment-related toxicities.