J Gynecol Oncol.  2018 Nov;29(6):e97. 10.3802/jgo.2018.29.e97.

Postoperative chemoradiotherapy versus radiotherapy alone for elderly cervical cancer patients with positive margins, lymph nodes, or parametrial invasion

• Cushman TR
• Haque W
• Menon H
• Rusthoven
• Butler EB
• Teh BS
• Verma V

• KMID: 2431242
• DOI: http://doi.org/10.3802/jgo.2018.29.e97

Abstract

OBJECTIVE
Women with cervical cancer (CC) found to have positive surgical margins, positive lymph nodes, and/or parametrial invasion receive a survival benefit from postoperative chemoradiotherapy (CRT) vs. radiation therapy (RT) alone. However, older women may not benefit to the same extent, as they are at increased risk of death from non-oncologic causes as well as toxicities from oncologic treatments. This study sought to evaluate whether there was a survival benefit of CRT over RT in elderly patients with cervical cancer.
METHODS
The National Cancer Database was queried for patients ≥70 years old with newly diagnosed IA2, IB, or IIA CC and positive margins, parametrial invasion, and/or positive nodes on surgical resection. Statistics included logistic regression, Kaplan-Meier overall survival (OS), and Cox proportional hazards modeling analyses.
RESULTS
Altogether, 166 patients met inclusion criteria; 62 (37%) underwent postoperative RT and 104 (63%) underwent postoperative CRT. Younger patients and those living in areas of higher income were less likely to receive CRT, while parametrial invasion and nodal involvement were associated with an increased likelihood (p < 0.05 for all). There were no OS differences by treatment type. Subgroup analysis by number of risk factors, as well as each of the 3 risk factors separately, also did not reveal any OS differences between cohorts.
CONCLUSION
In the largest such study to date, older women with postoperative risk factor(s) receiving RT alone experienced similar survival as those undergoing CRT. Although causation is not implied, careful patient selection is paramount to balance treatment-related toxicity risks with theoretical outcome benefits.

Keyword

Chemotherapy; Elderly; Geriatrics; Cervical Cancer; Radiation Therapy

MeSH Terms

Aged*
Chemoradiotherapy*
Cohort Studies
Drug Therapy
Female
Geriatrics
Humans
Logistic Models
Lymph Nodes*
Patient Selection
Proportional Hazards Models
Radiotherapy*
Risk Factors
Uterine Cervical Neoplasms*