Abstract 566P
Background
Current management recommendations for patients with stage IVB cancer of the uterine cervix include platinum-based chemotherapy (CT) combined with bevacizumab and/or pembrolizumab. Radiation therapy (RT) is offered selectively to control pelvic disease. Limited data is available evaluating the role of RT for stage IVB disease. We aim to study the effect of definitive chemoradiation (CRT) on progression free survival (PFS), overall survival (OS) and toxicity in patients with stage IVB.
Methods
A cervical cancer database containing 546 patients treated between 2005-2021 at a tertiary academic medical center was reviewed retrospectively to identify patients with stage IVB disease according to FIGO (2018). Patient characteristics and treatment parameters were recorded. Toxicity was assessed according to CTCAE v5. Cox multivariate analysis was used to identify parameters associated with PFS, OS and treatment toxicity. Kaplan Meir method was used to estimate PFS, OS, and toxicity.
Results
Thirty-six patients with stage IVB cervical cancer were identified. Median age was 52 years (range 28-78), 17 had comorbidities (47%) and 14 were smokers (39%). Pathology subtypes were squamous cell carcinoma (n=24, 37%), adenocarcinoma (n=8, 22%) and clear cell carcinoma (n=4, 11%). Sites of metastasis were supradiaphragmatic lymphatics (n=9, 25%), inguinal lymphatics (n=6, 17%), peritoneal (n=6, 17%), bone (n=5, 14%), ovary (n=5, 14%) and visceral organs (n=5, 14%). Patients were treated with definitive CRT (n=27) or CT alone (n=9). CT regimens used were platinum based. RT was given to the pelvic tumor using external beam (median dose 45 Gray) and brachytherapy (27.5 Gray). PFS (20 vs. 11 months, p < .001) and OS (49 vs. 32 months, p = .25) were longer in the CRT group than the CT group. Distant recurrences were less common in the CRT than the CT group (11/27 41% vs 9/9 100% p = .001). All long-term survivors had lymphatic metastasis only and received CRT (inguinal n=3, supradiaphragmatic n=1). Three patients suffered major treat related complications (fistula).
Conclusions
Patients with stage IVB cervical cancer may benefit from use of definitive CRT.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.