Prognostic analysis of doublet agent concurrent chemoradiotherapy in locally advanced cervical cancer: A propensity score analysis.

Abstract

e17514 Background: Platinum-based concurrent chemoradiotherapy (CCRT) is the current standard treatment for patients with locally advanced cervical cancer (LACC). Previous reports showed that doublet agent CCRT can provide better prognosis than single agent CCRT. However, several controversies surround the doublet agent regimen. This retrospective study compared the efficacy and safety of cisplatin and nedaplatin in doublet agent CCRT by propensity score (PS) matching. Methods: Information on patients with stage IIB-IIIC2 cervical cancer who received doublet agent CCRT from January 2015 to December 2020 were collected. The chemotherapy regimen was docetaxel (75mg/m2) combined with carboplatin (AUC = 4-5) / cisplatin (50–70mg/m2) / nedaplatin (50-75mg/m2) once every 3 weeks. All patients underwent external-beam radiotherapy with intensity-modulated radiotherapy at a dose of 45–50 Gy/25fx to the pelvis with or without involving the para-aortic region and 60 Gy/25fx to gross disease in the lymph nodes, and 2-dimensional intracavitary brachytherapy with dose of 30 Gy/5fx to point A. Patients were classified into the cisplatin group and nedaplatin group. Treatment outcomes were compared between the two groups after 1:1 ratio PS matching adjusted for age, BMI, FIGO stage, pathology, tumor diameter, differentiation, complication, and cycles of chemotherapy. Categorical variables were compared using the χ2 test or Fisher's exact test. Clinical outcomes were analyzed using the Kaplan–Meier method with log-rank test. Results: There are 295 patients enrolled, median age 55 years (32–73 years). The median follow-up time was 38 months (5–77 months). The median number of chemotherapy cycle is 4 (1–6 cycles). The 5-year overall survival (OS) and progression-free survival (PFS) rates were 82.5% and 80.4%, respectively. After PS matching, there were 83 patients each in the nedaplatin group and cisplatin group. All background factors between the two groups were well-balanced. There was no significant difference between the cisplatin and nedaplatin groups in terms of objective response rate (97.6% and 98.8%, p = 0.212), 5-year OS rate (96.5 vs.69.8, p = 0.066), and PFS rate (90.8 vs.72.4, p = 0.166). Also, there was no significant difference between the cisplatin and nedaplatin groups in terms of hematological toxicity (36.1% vs. 28.9%, p = 0.408), nausea and vomiting (19.3% vs. 20.4, p = 0.874), radiation proctitis (25.3% vs. 14.5%, p = 0.535), and radiation proctitis (12% vs.9.6%, p = 0.212). Conclusions: Doublet agent concurrent chemoradiotherapy is feasible, safe, and shows high efficacy in LACC patients. Here, the cisplatin group and nedaplatin group have similar prognosis and side effects, suggesting that nedaplatin and cisplatin are equivalent and can be replaced with each other for concurrent doublet agent CCRT.