Abstracts Presented at the 2022 Emirates Oncology Conference: November 25-27, 2022, Abu Dhabi, United Arab Emirates

INTRODUCTION: Cervical cancer is the fourth most frequently diagnosed cancer and the fourth leading cause of cancer death in women, with an estimated 604,000 new cases and 342,000 deaths worldwide in 2020. Globally, the average age at diagnosis of cervical cancer was 53 years, ranging from 44 years to 68 years. The global average age at death from cervical cancer was 59 years, ranging from 45 years to 76 years. Cervical cancer ranked in the top three cancers affecting women younger than 45 years in 146 (79%) of 185 countries assessed. Around 85% of the global burden occurs in the less-developed regions, where cervical cancer accounts for almost 12% of all female cancers. The anatomical location, the disease extension and survival outcomes are the key factors to define the staging of disease. The treatment of the patients depends on staging and prognostic groups. Disease bulk and lymph node involvement are key prognostic factors. SCC constitutes more than 75% of all diagnosed cervical cancers however lately the incidence of adenocarcinoma has been rising⁶. Various histological and clinical factors such as tumor size⁷ parametrial invasion, cervical stromal invasion depth, LVSI, FIGO Stage, tissue histology, tumor grade, and LN metastasis are associated with survival and prognosis in cervical cancer patients. AIM: This retrospective study aimed to determine the long-term clinical outcomes and to identify the prognostic factors that impact the survival of patients with cervical cancer in the United Arab Emirates (UAE). METHODS: All patients with cervical cancer treated with concurrent Cisplatin chemotherapy and Radiotherapy followed by High dose rate brachytherapy were identified from the Tawam hospital database. Patient demographics, staging investigations, treatment details and outcomes were compiled and analyzed. Kaplan-Meier curves were used to estimate disease-free survival (DFS) rates of treated survival cancer patients, while the log-rank test was used to compare differences in DFS across categories of selected clinical and demographic factors. Ethical approval was obtained from Tawam Human Research Ethics Committee. RESULTS: Between January 2009 and December 2021, we identified 275 patients with cervical cancer meeting the inclusion criteria for this study. Patients were staged with International Federation of Gynecology and Obstetrics (FIGO) system and detailed in Tables 1 and 2. The median age of the patients was 48 years (IQR=46-64). Majority of the patients (87.6%) were at stage IIB and above. Median follow-up for the entire group was 21.4 months (IQR=7.4-40.2). The overall 5-year DFS rate was 63%. The 5-year DFS rates for Stage II, III and IVA patients were 85%, 48% and 33%, respectively [P < 0.001] (Fig 1) which is similar to the previous findings in larger trials. In other factors lymph nodes was also found to be significantly associated with DFS rates (Figs 2 and 3). CONCLUSION: This is the largest study from UAE to assess outcomes and prognostic factors for cervical cancer patients receiving radical chemo-radiotherapy. Outcomes from our cohort were comparable to published international standards. Lymph node involvement and higher FIGO stage were independent poor prognostic factors for 5-year DFS. Our findings demonstrate that concurrent chemo-radiotherapy with cisplatin and HDR brachytherapy is safe and effective treatment as per International guidelines. However, although concurrent chemo-radiotherapy is a very effective regimen for cervical cancer, newer and more effective treatment strategies may be needed for patients with poorer prognoses such as those identified in this study. Since majority of our patients were at advanced stage at diagnosis, more robust screening and awareness programs are required.