The role of obesity in treatment planning for early-stage cervical cancer

Abstract

Objectives: There is limited data comparing radical hysterectomy (RH) to definitive radiation therapy (RT) for early stage cervical cancer. National guidelines recommend RH when feasible given the potential for long term morbidity with definitive RT. Management of obese patients with early stage cervical cancer is controversial despite evidence of non-inferior survival in obese patients undergoing RH. Our aims were to 1) describe patient factors affecting disposition to RH versus RT in patients who were RH candidates by clinical stage (CS), 2) compare differences in progression free survival (PFS) and overall survival (OS), and 3) compare RH outcomes for obese (BMI of 30) and non-obese patients. Download : Download high-res image (469KB) Download : Download full-size image Methods: This was a single institution retrospective chart review of all cervical cancer patients from 2001-2019. Patients who had a primary RH or were candidates for RH based on CS at presentation were included in the final cohort. Demographic, clinicopathologic and treatment outcomes were collected for each group. Univariable and multivariable analyses were used to identify factors influencing disposition to RH versus RT. Kaplan-Meier and Cox proportional hazard (PH) models were used to analyze PFS and OS. Results: The final cohort included 260 patients (RH=221 (85%), RT=39 (15%)). RT patients were significantly older (58.2 years vs 43.8 years, p Conclusions: There is limited data comparing RH vs RT for early stage disease; however, RT can be associated with long-term morbidity. In this cohort of RH-eligible cervical cancer patients, obesity was a driving factor for disposition to RT. Studies demonstrate that RH is feasible and safe in obese patients with no statistically significant difference in PFS or OS when compared to non-obese patients. Thus, we advocate that the decision for disposition to RT should not be based on obesity alone.