In a study reported in JAMA Oncology, Agusti et al found that the addition of chemotherapy to adjuvant radiotherapy was not associated with improved overall survival in patients with intermediate-risk cervical cancer.
Study Details
The study involved National Cancer Database data on patients with a diagnosis of 2018 International Federation of Gynecology and Obstetrics stage IB cervical carcinoma (squamous cell carcinoma, adenosquamous carcinoma, or adenocarcinoma) of intermediate risk who received adjuvant radiotherapy after radical hysterectomy from January 2010 through December 2020. The primary aim of the analysis was to determine the difference in overall survival among patients receiving concurrent chemoradiotherapy vs radiotherapy alone.
Key Findings
A total of 1,116 patients were included in the analysis; of these, 486 (43.5%) received concurrent chemoradiotherapy. Chemotherapy use was more likely in patients with adenocarcinoma or adenosquamous histology vs squamous cell carcinoma (risk ratio [RR] = 1.26, 95% confidence interval [CI] =1.10–1.44) and in those with tumors > 4 cm (RR vs 2–4 cm = 1.31, 95% CI = 1.14–1.51).
Propensity score matching produced a cohort of 868 patients (434 in each group). For the radiotherapy-alone group vs the chemoradiotherapy group, the 5-year and 10-year survival probabilities were 87% (95% CI = 86%–88%) vs 87% (95% CI = 86%–87%) and 77% (95% CI = 76%–78%) vs 82% (95% CI = 81%–82%), with a hazard ratio of 0.85 (95% CI = 0.59–1.23, P = .38). Subgroup analyses according to histology, presence of lymphovascular space invasion, tumor size (2–4 cm vs > 4 cm), surgical approach, and use of adjuvant brachytherapy showed no significant differences in overall survival between the two groups.
The investigators concluded: “The results of this cohort study suggest that adding chemotherapy to radiotherapy was not associated with improved overall survival for patients with intermediate-risk cervical cancer.”
Nuria Agusti, MD, of The University of Texas MD Anderson Cancer Center, is the corresponding author for the JAMA Oncology article.
Disclosure: The study was supported by grants from the National Institutes of Health. For full disclosures of all study authors, visit jamanetwork.com.
