Patterns of care for cervical cancer in Auckland, New Zealand, 2003-2007

Introduction: The purpose of this review is to document current patterns of care for the International Federation of Gynecology and Obstetrics (FIGO) stage IB1 to IVA cervical cancer in a New Zealand cancer centre. Methods: This is a retrospective review of women with newly diagnosed FIGO Stage IB1-IVA cervical cancer in the Auckland/Northland regions between 2003 and 2007. Results: Two hundred seven patients were identified. Fifty-three percent were stage IB, 24% stage II, 19% stage III and 3% stage IVA. Factors associated with stage >= IIB were age > 50, lack of participation in cervical screening and public first specialist assessment. Ninety percent (90/100) of stage IB1 patients and 73% (8/11) of stage IB2 patients were treated with primary surgery. Thirty-eight percent of surgically treated stage IB1 and 100% of surgically treated stage IB2 tumours had indications for adjuvant radiotherapy. Radiotherapy utilisation rates were: stage IB 49% (IB1 44%, IB2 91%); stage II 93%; stage III 90%; and stage IVA 71%. Brachytherapy utilisation rate (BTU) for stages IIB to IVA was 64% overall and 75% in definitively treated patients. Seventy-five percent of patients treated with definitive radiotherapy received concurrent cisplatin chemotherapy. Conclusion: Both radiotherapy and brachytherapy utilization rates were below optimal and are being addressed. No formal surgical or chemotherapy utilisation estimates exist for comparison; however, the use of concurrent cisplatin chemotherapy was similar to other groups. A high rate of adjuvant (chemo)radiotherapy was noted in surgically treated Stage IB patients, suggesting a need for an increased consideration of primary chemoradiotherapy in these patients to avoid the unnecessary toxicity of trimodality therapy. Future outcome analysis is planned.