Efficacy and Safety of Local Radiotherapy Combined with Chemotherapy ± Bevacizumab in the Treatment of Patients with Advanced and Recurrent Metastatic Cervical Cancer

Abstract

To observe the efficacy and safety of local radiotherapy combined with chemotherapy ± bevacizumab in the treatment of patients with advanced or recurrent metastatic cervical cancer. A total of 53 patients with advanced and recurrent metastatic cervical cancer who had received local radiotherapy combined with chemotherapy ± bevacizumab in Affiliated Cancer Hospital of Guizhou Medical University from July 2018 to October 2021 were collected. The recurrence types included 21 patients of pelvic recurrence, 7 patients of distant metastasis, 14 patients of complex pelvic recurrence and distant metastasis, and 11 patients of advanced stage (initial diagnosis stage IVB). The primary endpoints were objective response rate (ORR) and disease control rate (DCR). The secondary endpoints were progression-free survival (PFS), overall survival (OS) and incidence of adverse reactions. (1) Complete response (CR) was achieved in 4 patients (7.5%), partial response (PR) in 34 patients (64.2%), stable disease (SD) in 12 patients (22.6%), and disease progression (PD) in 3 patients (5.7%), ORR was 71.7%, DCR was 94.3%. (2) The follow-up time was 5.3 to 45.7 months, the median OS was 29.3 months, the median PFS was 15.7 months, the one-year and two-year OS were 83.0% and 59.2%, and the 1-year and two-year PFS were 62.2% and 34.4%. (3) Recurrence type, tumor size at the time of recurrence, and efficacy after radiotherapy were significant factors for PFS and OS rates in multivariate analysis. (4) The main adverse reactions were myelosuppression, gastrointestinal reaction and urinary reaction. Grade IV leukopenia occurred at 13.2%, grade IV neutropenia at 11.3%, grade IV thrombocytopenia at 15.1%, and grade IV anemia at 5.7%, all of which were tolerable. The gastrointestinal and urinary reactions were mainly grade I-II, and the incidence of vesical or rectovaginal fistulas was about 7.5% (2 patients had rectovaginal fistulas and 2 patients had vesto-vaginal fistulas). Local radiotherapy combined with chemotherapy ± bevacizumab can improve the efficacy and survival of patients with advanced and recurrent metastatic cervical cancer. Adverse reactions are tolerable and may provide survival benefits in these patients.