Disease characteristics, treatment, and overall survival outcomes of patients with locally advanced cervical cancer referred for radiation therapy in Johannesburg, South Africa: a 2-year retrospective study

PURPOSE: We assessed the association between baseline patient characteristics, disease stage, and treatment-related factors and overall survival among women with locally advanced, non-metastatic cervical cancer in South Africa. PATIENTS AND METHODS: We retrospectively analysed data from 642 women with 2018 International Federation of Gynaecology and Obstetrics (FIGO) stage IB3-IVA cervical cancer who were referred for and deemed eligible for radiotherapy at a public tertiary hospital in South Africa between January 2021 and December 2022. All women discussed at the multidisciplinary team (MDT) meeting were included, irrespective of whether treatment was ultimately initiated. Demographic and clinical characteristics, treatment timelines, and survival outcomes were assessed. Multivariable Cox proportional‑hazards models were used to identify factors associated with overall survival. RESULTS: Of the 642 women, 54.1% were aged < 50 years and 60.3% were living with HIV. The stage distribution was: IB3, 1.7%; II, 43.5%; III, 50.1%; and IVA, 4.7%. The median time to treatment initiation was ~4 months; the median overall treatment duration was 63 days. The 2-year overall survival rate was 57.2% and varied by stage (IB3 and II, 70.0%; III, 49.3%; IVA, 12.4%; p < 0.001). On multivariable Cox regression analysis, worse survival was independently associated with Eastern Cooperative Oncology Group performance status 2-4 [vs. 0 and 1; adjusted hazard ratio (aHR), 1.75], stage III (vs. IB3 and II; aHR, 1.46) stage IVA (vs. IB3 and II; aHR, 2.02), and receipt of radiotherapy alone (vs. chemoradiation; aHR, 1.96). A significant interaction between EQD2 and overall treatment duration was observed. Patients receiving EQD2 <80 with treatment duration <56 days was associated with worse overall survival (aHR 2.65). HIV status was not associated significantly with survival. CONCLUSIONS: Overall Survival in women with locally advanced cervical cancer in South Africa was associated with disease stage, baseline patient characteristics, and treatment-related factors. Interventions targeting timely delivery of standard of care may improve survival in this setting.