Definitive Pelvic Radiation Therapy Plus Chemotherapy and Survival in Newly Diagnosed Metastatic Cervical Cancer
In a study using National Cancer Database data reported in JAMA Oncology, Wang et al found that definitive pelvic radiation therapy plus chemotherapy was associated with improved survival vs chemotherapy alone in newly diagnosed metastatic cervical cancer.
The study included data from 3,169 patients treated between 2004 and 2014; of these, 808 received chemotherapy alone and 2,361 received pelvic chemoradiation. Patients who received no treatment or radiation therapy alone or who underwent surgery were not included in the analysis. Multivariate and propensity score–matched analyses included radiation, age, year of diagnosis, race, comorbidity score, tumor grade, clinical tumor stage and nodal stage, facility type, insurance, and metastatic site. Patients had a mean age of 54 years (range = 19–90 years).
Survival Outcomes
Median follow-up was 13.3 months (range = 0.1–151 months). Median overall survival was 15.6 months in the chemoradiation group vs 10.1 months in the chemotherapy group (univariate analysis hazard ratio [HR] = 0.65, P < .001; multivariate analysis HR = 0.72, P < .001); 2-year survival was 36% vs 23%. On propensity score–matched analysis, median survival was 14.4 vs 10.6 months (P < .001).
Median survival was longer among patients who received therapeutic radiation with a dose ≥ 45 Gy vs < 45 Gy (18.5 vs 10.2 months) and those who received external-beam radiation therapy plus brachytherapy vs external-beam radiation therapy alone (27.5 vs 12.9 months; all P < .001). Chemoradiation was associated with improved survival among all examined subgroups, including patients with distant node–only metastasis (HR = 0.64, P < .001), organ-only metastasis (HR = 0.71, P < .001), and both nodal and organ metastasis (HR = 0.83, P = .02).
The investigators concluded, “Newly diagnosed metastatic cervical cancer managed with definitive pelvic radiation therapy and chemotherapy was associated with substantially longer survival than treatment with chemotherapy alone. Prospective trials evaluating definitive local radiation therapy for metastatic cervical cancer are warranted.”
Matthew T. Ballo, MD, of the Department of Radiation Oncology, University of Tennessee Health Science Center, is the corresponding author for the JAMA Oncology article.
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