Incorporation of whole pelvic radiation into treatment of stage IVB cervical cancer: A novel treatment strategy

Chemotherapy is the standard treatment in stage IVB cervical cancer (CC). However, given that many women have a significant pelvic disease burden, whole pelvic radiation (WPR) in addition to chemotherapy for primary treatment may have utility. The aim of this study was to compare the overall surviva...

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Bibliographic Details
Published in:Gynecologic oncology 2020-01, Vol.156 (1), p.100-106
Main Authors: Perkins, Victoria, Moore, Kathleen, Vesely, Sara, Matsuo, Koji, Mostofizadeh, Sayedamin, Sims, Travis T., Lea, Jayanthi, Barnes, Dominique, Chen, Sixia, Carlson, Matthew, Roman, Lynda, Monk, Bradley J., Holman, Laura L.
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Antineoplastic Combined Chemotherapy Protocols - therapeutic use
Cervical cancer
Chemoradiotherapy
Chemotherapy
Cisplatin - administration & dosage
Female
Humans
Middle Aged
Neoplasm Staging
Paclitaxel - administration & dosage
Pelvis - radiation effects
Progression-Free Survival
Radiation
Radiotherapy - methods
Retrospective Studies
Stage IVB
Survival
Survival Analysis
Uterine Cervical Neoplasms - drug therapy
Uterine Cervical Neoplasms - pathology
Uterine Cervical Neoplasms - radiotherapy
Young Adult
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Summary:Chemotherapy is the standard treatment in stage IVB cervical cancer (CC). However, given that many women have a significant pelvic disease burden, whole pelvic radiation (WPR) in addition to chemotherapy for primary treatment may have utility. The aim of this study was to compare the overall survival (OS) and complication rates between women who received both WPR and chemotherapy (CT) versus CT alone in the management of stage IVB CC. A multi-institutional, IRB-approved, retrospective review of patients (pts) with stage IVB CC, diagnosed between 2005 and 2015, was performed. Descriptive statistics of the demographic, oncologic, and treatment characteristics were performed. OS was estimated using the Kaplan Meier method. A total of 126 pts met inclusion criteria. Thirty one patients elected for hospice care at diagnosis and were excluded from further analysis. In the remaining population, median age was 53 yrs. The majority (72%) had squamous cell carcinoma and 82% had FIGO grade 2 or 3 tumors. Thirty four patients (35.8%) received WPR in addition to CT as a part of planned primary therapy and 64.2% (n = 61) received CT alone, with 88.2% and 80.3% receiving a cisplatin-based chemotherapy regimen, respectively. The OS was significantly longer in the WPR with CT group (41.6 vs 17.6 mo, p  0.05). This study found WPR in addition to CT gives a significant OS benefit. Further study is warranted to determine which subgroups may benefit the most from this novel treatment strategy. •WPR for pelvic disease burden in Stage IVB cervical cancer may have symptomatic utility.•The study identified a statistically significant survival benefit by adding WPR to CT in Stage IVB cervical cancer.•There is no difference in rates of pelvic disease-related morbidity between CT alone and WPR plus CT groups.
ISSN:0090-8258
1095-6859
DOI:10.1016/j.ygyno.2019.10.033