NATIONAL HARBOR, MD. – Whole pelvic radiation delivered in addition to chemotherapy in women who present with stage IVB cervical cancer confers significant 12-month overall and progression-free survival benefits, according to findings from a multi-institutional retrospective review.
Of 127 patients diagnosed during 2005-2015 at four academic high-volume centers, 31 received no treatment or elected hospice care and, of the remaining patients, 34 received whole pelvic radiation (WPR) in addition to chemotherapy, and 62 received chemotherapy alone, which is the standard of care. The median overall survival was 14.1 vs. 6.9 months with vs. without WPR, and the median progression-free survival was 10 vs. 5 months, respectively, Victoria B. Perkins, MD, said at the annual meeting of the Society of Gynecologic Oncology.
Of note, the rates of pelvic-related morbidity, including ureteral obstruction, vaginal or rectal bleeding, pelvic infection, pelvic pain, and fistula, did not differ significantly between the groups, said Dr. Perkins of the University of Oklahoma Health Sciences Center, Oklahoma City.
Study subjects were women with a median age of 54 years. A little more than a third (36%) were white, 35% were Hispanic, and 16% were black. Most (75%) had squamous cell carcinoma, and 95% were grade 2 or 3.
There were no significant differences in the demographics, location of [metastatic] disease, or distribution of chemotherapy type between the two groups, she said, noting that “interestingly, 26% of patients in the chemotherapy alone group received additional bevacizumab, compared to only 12% in the whole pelvic radiation with chemotherapy group.
“This could reflect the change in treatment strategy with the approval of bevacizumab during the treatment period,” Dr. Perkins noted.
About 5% of women have stage IVB cervical cancer at the time of diagnosis, but 5-year survival in these women is only about 15%.
“The mainstay of treatment is platinum and taxane with or without bevacizumab. In clinical practice, treatment of stage IVB disease varies,” Dr. Perkins said.
One strategy follows the guidance of phase III trials looking at chemotherapy with palliative radiation as needed.
“However, a significant number of patients experience morbidity and mortality directly related to their pelvic disease, such as vaginal bleeding, ureteral obstruction, fistulization, infections, and pain. Thus, an alternative approach is aimed at treating bulky pelvic disease with whole pelvic radiation followed by systemic chemotherapy with the goal to control symptoms and theoretically reduce recurrences in the pelvic field, which can be highly problematic in terms of symptomatic control,” she said, noting that this novel approach has not been formally studied.
The aim of the current review was to determine if WPR with chemotherapy would reduce pelvic morbidity and improve overall and progression-free survival.
“Survival in stage IVB disease remains extremely poor. Perhaps adding whole pelvic radiation to systemic chemotherapy has utility without increasing morbidity. However, the addition of whole pelvic radiation did not improve pelvic-related morbidity as previously hypothesized,” she said.
The study was limited by varied chemotherapy regimens in both groups and by changes in standard treatment practice during the span of study. It also was limited by the retrospective design, small sample size, and lack of quality of life data, but the findings support further study regarding subgroups of patients who could benefit the most from this treatment strategy, she concluded, noting, however, that such study is challenging because of the rarity of stage IVB disease.
Dr. Perkins reported having no disclosures.