TY - JOUR
T1 - Outcomes and patterns of relapse after definitive radiation therapy for oligometastatic cervical cancer
AU - Ning, Matthew S.
AU - Ahobila, Vamsi
AU - Jhingran, Anuja
AU - Stecklein, Shane R.
AU - Frumovitz, Michael
AU - Schmeler, Kathleen M.
AU - Eifel, Patricia J.
AU - Klopp, Ann H.
N1 - Funding Information:
Supported in part by Cancer Center Support (Core) Grant CA016672 from the National Institute of Cancer, National Institutes of Health , to The University of Texas MD Anderson Cancer Center.
Publisher Copyright:
© 2017
PY - 2018/1
Y1 - 2018/1
N2 - Purpose Survival rates for women with metastatic cervical cancer are low, with limited management options. Definitive radiation therapy (RT) for oligometastatic disease has led to prolonged survival in other malignancies, but this approach has yet to be systematically studied for cervical cancer. Methods and materials We evaluated 38 patients who received definitive RT to oligometastatic sites of cervical cancer at a single institution from 2002 to 2015. Patients presented with synchronous (n = 9) or metachronous (n = 15) oligometastatic disease to supraclavicular (SCV) nodes, or with recurrent disease in mediastinum (n = 10) or lung (n = 7). Three patients were treated for both SCV and mediastinal sites, and six patients were treated for para-aortic or pelvic recurrences along with oligometastatic sites. Most received chemotherapy: induction (n = 5), concurrent (n = 24), or adjuvant (n = 5). Outcomes were evaluated via Kaplan-Meier, and associations were examined via Cox proportional hazards modeling. Results Median follow-up was 35.2 months (range 3.1–94.7). Median overall survival (OS) was 50.7 months from end of RT, with 2-year and 3-year OS rates of 74% and 65%. Median progression-free survival (PFS) was 21.7 months, with 1-year and 2-year PFS rates of 63% and 48%. Of the 38 patients, 21 (55%) experienced progression, at a median time of 24.8 months. There was one in-field failure. Other relapses occurred regionally (n = 10) and distally (n = 12), with two patients experiencing both. The most common site of recurrence following treatment of SCV disease was mediastinum (n = 7). The incidence of grade ≥ 3 toxicity from treatment of oligometastatic sites was < 3%. Conclusions Definitive RT to sites of oligometastatic cervical cancer can result in excellent local control, favorable outcomes, and even achieve long-term survival for carefully selected patients, with minimal RT-associated toxicity.
AB - Purpose Survival rates for women with metastatic cervical cancer are low, with limited management options. Definitive radiation therapy (RT) for oligometastatic disease has led to prolonged survival in other malignancies, but this approach has yet to be systematically studied for cervical cancer. Methods and materials We evaluated 38 patients who received definitive RT to oligometastatic sites of cervical cancer at a single institution from 2002 to 2015. Patients presented with synchronous (n = 9) or metachronous (n = 15) oligometastatic disease to supraclavicular (SCV) nodes, or with recurrent disease in mediastinum (n = 10) or lung (n = 7). Three patients were treated for both SCV and mediastinal sites, and six patients were treated for para-aortic or pelvic recurrences along with oligometastatic sites. Most received chemotherapy: induction (n = 5), concurrent (n = 24), or adjuvant (n = 5). Outcomes were evaluated via Kaplan-Meier, and associations were examined via Cox proportional hazards modeling. Results Median follow-up was 35.2 months (range 3.1–94.7). Median overall survival (OS) was 50.7 months from end of RT, with 2-year and 3-year OS rates of 74% and 65%. Median progression-free survival (PFS) was 21.7 months, with 1-year and 2-year PFS rates of 63% and 48%. Of the 38 patients, 21 (55%) experienced progression, at a median time of 24.8 months. There was one in-field failure. Other relapses occurred regionally (n = 10) and distally (n = 12), with two patients experiencing both. The most common site of recurrence following treatment of SCV disease was mediastinum (n = 7). The incidence of grade ≥ 3 toxicity from treatment of oligometastatic sites was < 3%. Conclusions Definitive RT to sites of oligometastatic cervical cancer can result in excellent local control, favorable outcomes, and even achieve long-term survival for carefully selected patients, with minimal RT-associated toxicity.
KW - Cervical
KW - Consolidation
KW - Definitive
KW - Oligometastases
KW - Radiation therapy
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U2 - 10.1016/j.ygyno.2017.10.017
DO - 10.1016/j.ygyno.2017.10.017
M3 - Article
C2 - 29089122
AN - SCOPUS:85032340750
SN - 0090-8258
VL - 148
SP - 132
EP - 138
JO - Gynecologic oncology
JF - Gynecologic oncology
IS - 1
ER -