Identifying Leukopenia, Renal Dysfunction and Other Factors Limiting Concomitant Chemoradiotherapy in Locally Advanced Cervical Cancer: A Way to Focus on the Importance of Supportive Care and Potentially Improve Treatment Results?

Introduction: Concomitant chemoradiotherapy (CHRT) with weekly cisplatin and image-guided adaptive brachytherapy (IGABT) is the standard treatment for unresectable locally advanced cervical cancer. It has been shown that receiving five or more cycles of concomitant chemotherapy (CHT) significantly improves recurrence-free and overall survival. In this study, we analysed the factors contributing to the omission of concomitant chemotherapy within a patient cohort. Methods: In this single-centre retrospective study, we analysed medical records of 191 patients treated at our facility (Department of Oncology and Radiotherapeutics, University Hospital Pilsen, Czech Republic) from 2012 to 2024 to identify factors preventing optimal CHT administration. Included patients were those with newly diagnosed locally advanced, unresectable cervical cancer, where concomitant platinum-based CHRT with IGABT was indicated. Results: Of the patients, 15% (29/191) received no concomitant CHT, primarily due to concerns about toxicity, patient frailty/comorbidities, and renal insufficiency, with a statistically significant age difference in those who received CHT versus those who did not: mean 55.03 (±SD11.89) vs. 63.52 (±SD12.14) years (95% CI 3.74-13.23, p=0.0005). Among patients who initiated concomitant CHT but received four or fewer cycles (92/162, 57%), leukopenia was the most common independent limiting factor, followed by decreased renal function. Other factors included nausea, diarrhea, and administrative reasons. Conclusion: Leukopenia and renal dysfunction were primary barriers to completing optimal concomitant CHT in a significant number of patients. We advocate for increased emphasis on supportive care, including granulocyte colony-stimulating factor (G-CSF) use in leukopenia/neutropenia prevention or treatment, and meticulous management of renal functions. Individualized renal assessment, not just 'cisplatin-unfit' criteria, is crucial. Further research on G-CSFs in CHRT is warranted.