In the Journals Plus

Addition of radiation to chemotherapy confers survival benefit for cervical cancer

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July 26, 2018

Patients who received pelvic chemoradiation for the treatment of newly diagnosed metastatic cervical cancer had improved survival compared with those who received chemotherapy alone, according to a research letter published in JAMA Oncology.

“Definitive pelvic chemoradiation is the standard of care for locally advanced cervical cancer. However, the role of definitive local radiation therapy for metastatic cervical cancer has not been established,” Yuefeng Wang, MD, PhD, resident at The University of Tennessee Health Science Center, and colleagues wrote. “In addition, there is growing evidence that local therapies may be associated with an increase in survival among patients with some types of metastatic cancers.”

Researchers used the National Cancer Database to identify 3,169 women (mean age, 53.6 years) with metastatic cervical cancer who received chemotherapy with (n = 2,361) or without (n = 808) radiation.

Exclusion criteria included receiving no treatment, receiving treatment with radiation therapy alone, undergoing surgery or missing baseline variables.

Median follow-up was 13.3 months.

Patients who received chemoradiation demonstrated improved survival on univariate analysis (HR = 0.65; 95% CI, 0.6-0.71) and multivariate analysis (HR = 0.72; 95% CI, 0.66-0.79) compared with those who received chemotherapy alone.

In a propensity score-matched analysis, researchers observed a median survival of 14.4 months (95% CI, 12.8-15.7) among those who received chemoradiation compared with 10.6 months (95% CI, 9.7-11.3) among those who received chemotherapy alone.

Chemoradiation appeared associated with better survival compared with chemotherapy alone across all subgroups, including those for:

  • distant node-only metastasis (HR = 0.64; 95% CI, 0.54-0.7);
  • organ-only metastasis (HR = 0.71; 95% CI, 0.61-0.82); and
  • both nodal and organ metastasis (HR = 0.83; 95% CI, 0.7-0.98).

Those who received a therapeutic radiation dose of at least 45 Gy had longer median survival than those received smaller radiation doses (18.5 months; 95% CI, 17.4-19.9 vs. 10.2 months; 95% CI, 9.4-11.5; P < .001).

Researchers observed a similar association between those who received external beam radiation therapy plus brachytherapy compared with those who received external beam radiation therapy alone (27.5 months; 95% CI, 24.5-31.3 vs. 12.9 months 95% CI, 12.2-13.8; P < .001).

The limitations of the study included lack of information on specific chemotherapy agents, salvage therapies, performance status and disease-specific survival.

“Newly diagnosed metastatic cervical cancer managed with definitive pelvic radiation therapy and chemotherapy was associated with substantially longer survival than treatment with chemotherapy alone,” the researchers wrote. “Prospective trials evaluating definitive local radiation therapy for metastatic cervical cancer are warranted.” – by Cassie Homer

Disclosures: The researchers report no relevant financial disclosures.