Impact of obesity on treatment-related adverse events, disease recurrence, and survival in women with cervical carcinoma

To review and report the influence of body mass index (BMI) on oncologic outcomes and toxicity in women treated with radiotherapy for locally advanced cervical cancer. After obtaining institutional review board approval, we reviewed the records of patients with stage IB1 to IVB cervical cancer treated at our institution between 1983 and 2009. Eligible patients underwent definitive radiotherapy with external beam radiation therapy or chemoradiation and low dose rate (LDR) brachytherapy. Patient, tumor and treatment characteristics, treatment-induced adverse events (AEs), and treatment outcomes were reviewed and reported based on BMI category. This study identified 223 patients, consisting of stages I, II, III, and IV cervical cancer (36, 42, 16, and 6 %, respectively), and BMI categories < 18.5, 18.5-24.9, 25-29.9, and > 30 (8, 39, 22, and 31 %, respectively). Median follow-up was 30 months. Overweight and obese women (BMI > 25) were more likely to experience acute grade 3-4 skin AEs (p = 0.02). Underweight patients (BMI < 18.5) received higher bladder point radiation dose (p = 0.04) and had shorter distance between the bladder point and the point of maximum dose (p = 0.02). Women with BMI a parts per thousand yen30 had increased overall survival (OS) (multivariate hazard ratio [HR] 0.471, 95 % confidence interval [CI] 0.263-0.841, p = 0.01) and progression-free survival (PFS) (HR 0.513, 95 % CI 0.305-0.862, p = 0.01). Treatment-related outcomes differed based on patient BMI. Future prospective studies are justified to identify whether interventions such as image-guided and adaptive treatment planning and intensity-modulated radiation therapy (IMRT) are effective in reducing treatment-related AEs for obese and underweight patients.