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

Taylor R. Cushman, Waqar Haque, Hari Menon, Chad G. Rusthoven, E. Brian Butler, Bin S. Teh, Vivek Verma

Research output: Contribution to journalArticle

1 Scopus citations

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.

Original languageEnglish (US)
Article numbere97
JournalJournal of Gynecologic Oncology
Volume29
Issue number6
Early online dateAug 21 2018
DOIs
StatePublished - Nov 1 2018

Keywords

  • Cervical cancer
  • Chemotherapy
  • Elderly
  • Geriatrics
  • Radiation therapy

ASJC Scopus subject areas

  • Oncology
  • Obstetrics and Gynecology

Fingerprint Dive into the research topics of 'Postoperative chemoradiotherapy versus radiotherapy alone for elderly cervical cancer patients with positive margins, lymph nodes, or parametrial invasion'. Together they form a unique fingerprint.

Cite this