Bone involvement in patients with cervical carcinoma – a single institution cohort study
Thesis (MPhil)--Stellenbosch University, 2019.
Introduction Bony metastases in cervical carcinoma are rare, occurring on average in 4.6% of patients. Autopsy studies indicate that it is underdiagnosed. It is important to recognise bony infiltration as palliative radiotherapy can relieve pain and prevent pathological fractures. As survival after the diagnosis of bone involvement is short, an appropriate palliative care plan should be tailored according to the patients’ limited prognosis. Methods A retrospective cohort analysis of women with cervical cancer, diagnosed between January 2014 and December 2015, was undertaken. Demographic, treatment and follow up data were collected for all women with bone metastases confirmed by imaging. Descriptive statistics were generated. Results The cohort study identified 642 patients with cervical carcinoma, of which 25 (3.89%) were diagnosed with bone involvement. Ten patients had bone involvement at diagnosis of cervical cancer and 15 had bone metastases at recurrence, occurring a median of 286 days after primary treatment. Survival after the diagnosis of bone metastases was short, with 88% of patients dying within the first 6 months. Women with a low WHO performance status at diagnosis of bone metastases had a significantly shorter survival (p=0.024). When a previously described prognostic score was applied, those with a high score had a significantly shorter survival (median 61 days) than those with a low score (median 158 days) (p=0.0065). Conclusions Although bone metastases are rare in women with cervical cancer, they are important to recognise as radiotherapy is a useful modality for palliating bone pain and reducing pathological fractures. Health care workers should be vigilant, especially during the first 2 years of follow up, to increased analgesic use and chronic pain as these may indicate bone involvement. Use of a prognostic score is valuable in tailoring treatment and counselling patients and their families with regard to survival. Survival after the diagnosis of bone involvement is short and a patient’s quality of life may be greatly improved by an appropriate radiotherapy and palliative care plan.