Metastatic cervical cancer: pelvic CRT tied to superior OS vs chemotherapy

  • Wang Y & al.
  • JAMA Oncol
  • 26 Jul 2018

  • curated by Deepa Koli
  • Univadis Clinical Summaries
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Takeaway

  • Newly diagnosed patients with metastatic cervical cancer treated with definitive pelvic radiotherapy+chemotherapy (CRT) showed significant improvement in OS compared with chemotherapy alone.
  • Radiation dose ≥45 Gy, external beam radiation therapy (EBRT)+brachytherapy, and concurrent CRT improved OS.

Why this matters

  • Definitive pelvic CRT is the standard of care for locally advanced cervical cancer, but the evidence supporting its role in metastatic disease is limited.

Study design

  • Study of 3169 patients with newly diagnosed metastatic cervical cancer from National Cancer Database who received chemotherapy ± radiation therapy during 2004-2014.
  • Funding: None disclosed.

Key results

  • 808 patients received chemotherapy alone and 2361 were treated with pelvic CRT.
  • Median follow-up, 13.3 months.
  • Median OS improved significantly in patients who received CRT vs chemotherapy alone (15.6 vs 10.1 months; HR, 0.72; P<.001>
  • Propensity score-matched analysis showed superior median survival with CRT vs chemotherapy alone (14.4 vs 10.6 months; P<.001>
  • Median OS was longer in patients who received:
    • radiation therapy with a dose ≥45 vs
    • EBRT+brachytherapy+chemotherapy vs EBRT+chemotherapy (27.5 vs 12.9 months; HR [vs chemotherapy alone], 0.50; P<.001 and>
    • concurrent vs nonconcurrent chemoradiation (16.4 vs 14.3 months).

Limitations

  • Retrospective design.

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