Era Of Chemoradiation Research Articles

Thrombocytosis Is a Poor Prognostic Factor in Those Treated With Chemoradiation for Advanced Cervical Cancer [ID 2683596

INTRODUCTION: Prior to the addition of chemotherapy to radiation, thrombocytosis was seen as a poor prognostic factor for women with advanced cervical cancer. The objective of this study was to see in the chemoradiation era whether thrombocytosis was still a prognostic factor. METHODS: An IRB-approved study was performed analyzing all patients with cervical cancer receiving primary chemoradiation (cisplatin) as therapy over a 10-year period. Minimum follow-up was 30 months. Records were examined for initial platelet count at diagnosis, stage, grade, histology, and survival. Only patients receiving chemoradiation with stage IIa–IVb cervical cancer were studied and included in the final analysis. RESULTS: Two hundred nine with cervical cancer were diagnosed with 173 treated with primary chemoradiation. The most common stage was IIIb (88; 50.9%). The mean platelet counts of those receiving chemoradiation were significantly higher (396k/mL; 95% CI, 376–416k) than those with lower-stage disease (313k/mL; 292–334k) (P<.001). Of the 173 patients, 42 (24.3%) had a platelet count >450k/mL and 24 (13.9%) had a platelet count >500k/mL. Patients who died of disease had significantly higher initial platelet counts (mean 433k/mL; 95% CI, 407–458k) than those who were alive at the completion of follow-up (mean 326k/mL; 95% CI, 303–350k). None of the patients with an initial platelet count greater than 500k/mL was alive at the time of follow-up. CONCLUSION: High platelet count at initial diagnosis is a poor prognostic factor in those with cervical cancer treated by primary chemoradiation.

Prognostic impact of extranodal extension in resected head and neck squamous cell carcinomas in the era of postoperative chemoradiation: A retrospective monocentric study

BackgroundFor patients with locally advanced head and neck squamous cell carcinoma (LAHNSCC), surgery (S) followed by radiotherapy (RT) is a standard of care. Randomized controlled trials have shown that postoperative chemoradiation (CRT) increased the locoregional control (LRC) and overall survival (OS) in patient with R1-resection margin and/or extranodal extension (ENE). ENE has been introduced in the 8th TNM staging classification since its presence has been shown to have an independent adverse prognostic impact. The data supporting this finding were however mainly collected in the pre-CRT era. ObjectivesThe objective of this study was to challenge the adverse prognostic factor of ENE in the era of CRT. MethodsA retrospective cohort study was performed to evaluate patients diagnosed with LAHNSCC and undergoing a treatment by S and postoperative RT or CRT in Centre Léon Bérard, Lyon, France between 2003 and 2018. Patients with oral cavity, oropharyngeal, laryngeal and hypopharyngeal SCC were included. Results439 patients were included in the study. For patients with non-oropharyngeal p16-positive tumors without ENE, five-year OS, local control, and regional control (RC) reached 63.7%, 86.1%, and 94.9%, respectively; corresponding figures for patients with ENE reached, 42.6%, 77.5%, and 81.1%, respectively (p-value of 0.0006, 0.167, and 0.0005). In multivariable analysis, for non-oropharyngeal p16-positive tumors, ENE remained a poor prognostic factor for OS (RR = 1.74, 95%, CI = 1.16–2.61, p = 0.0069) and RC (RR 3.60, 95% CI =: 1.64–7.87, p = 0.0013). ConclusionIn the era or postoperative chemoradiation, pathological ENE remains an adverse prognostic factor for OS and RC.

Impact of Lumen Occlusion on Outcomes in Locally Advanced Rectal Adenocarcinoma

Rectal cancer presenting with intestinal obstruction has historically been associated with poor outcomes. However, most of these studies were published before the neoadjuvant chemoradiation era. We intended to look for the outcomes of patients with rectal cancer presenting with and without luminal occlusion. One hundred eighty-nine consecutive patients, compliant with the treatment protocol from January 2013 to May 2014 were included in the study. They were classified as lumen-occluding or non-lumen-occluding based on colonoscopy, and outcomes were compared in the 2 groups. The two groups had similar demographic profiles. Median follow-up time of the study cohort was 5 years. The 5-year overall survival was 72.2% and 54.8% in the lumen non-occluding and lumen-occluding group, respectively. This difference was not statistically significant (p–0.34). However, 5-year disease-free survival was 65.1% and 39.9% in the non-occluding group and lumen-occluding group, respectively (p = 0.02). This difference in disease-free survival was not significant on multivariate analysis (p–0.07). Lumen-occluding growths on colonoscopy are not associated with poor outcomes in today’s era.

EPID-15. RACIAL AND SOCIOECONOMIC DISPARITIES DIFFERENTIALLY AFFECT OVERALL AND CAUSE-SPECIFIC SURVIVAL IN GLIOBLASTOMA

Abstract BACKGROUND The prognostic role of racial and socioeconomic factors in patients with glioblastoma is controversially debated. We aimed to evaluate how these factors may affect survival outcomes in an overall and cause-specific manner using large, national cancer registry cohort data in the temozolomide chemoradiation era. METHODS The National Cancer Institute’s Surveillance, Epidemiology, and End Results database was queried for patients diagnosed with glioblastoma between 2005 and 2016. Overall survival was assessed using Cox proportional hazard models using disease intrinsic and extrinsic factors. Cause-specific mortality was assessed using cumulative incidence curves and modeled using multivariate cumulative risk regression. RESULTS A total of 28,954 patients met the prespecified inclusion criteria and were included in this analysis. The following factors were associated with all-cause mortality: age, calendar year of diagnosis, sex, treatment receipt, tumor size, tumor location, extent of resection, median household income, and race. Asian/Pacific Islanders and Hispanic Whites had lower mortality compared to Non-Hispanic Whites. Cause-specific mortality was associated with both racial and socioeconomic groups. After adjusting for treatment and tumor-related factors, Asian/Pacific and black patients had lower glioblastoma-specific mortality. However, lower median household income and black race were associated with significantly higher non-glioblastoma mortality. CONCLUSION Despite the aggressive nature of glioblastoma, racial and socioeconomic factors influence glioblastoma-specific and non-glioblastoma associated mortality. Our study shows that patient race has an impact on glioblastoma-associated mortality independently of tumor and treatment related factors. Importantly, socioeconomic and racial differences largely contribute to non-glioblastoma mortality, including death from other cancers, cardio- and cerebrovascular events.

Treatment patterns and outcomes for cerebellar glioblastoma in the concomitant chemoradiation era: A National Cancer database study

Cerebellar glioblastoma (GB) is much rarer than its supratentorial counterpart, and potentially of different molecular origin. Prior database studies are of limited size and reported on patients who preceded the validation of temozolomide. Thus, we provide an updated population-based analysis of the treatment trends and outcomes since the standardization of GB adjuvant chemoradiation. Patients diagnosed with primary cerebellar and supratentorial GB were identified from the National Cancer Database spanning 2005–2015. Patients were characterized by demographics, extent of resection, and adjuvant chemotherapy or radiation status. Cohorts were primarily and secondarily assessed for overall survival by tumor site and treatment history, respectively. A total of 655 patients with cerebellar GB were identified (0.6%). Cerebellar GB patients, compared to supratentorial GB were more likely to undergo a biopsy or subtotal resection (13.4% vs 9.3% and 16.0% vs 13.4%, p-value < 0.001), and less likely to pursue adjuvant therapy (48.4% vs 52.7%, p-value < 0.001). Overall median survivals were 9.3 and 9.4 months, respectively. On multivariable analysis, gross total resection, radiation, and chemotherapy were found to be predictors of improved overall survival (HR 0.77, p = 0.038; HR 0.67, p < 0.001; and HR = 0.77, p = 0.030, respectively). While many management principles are currently shared between cerebellar and supratentorial GB, aggressive regimens appear less frequently prescribed. Survival continues to match supratentorial outcomes and may benefit from future, systemic guidance by distinguishing molecular features.

Racial and socioeconomic disparities differentially affect overall and cause-specific survival in glioblastoma.

The prognostic role of racial and socioeconomic factors in patients with glioblastoma is controversially debated. We aimed to evaluate how these factors may affect survival outcomes in an overall and cause-specific manner using large, national cancer registry cohort data in the temozolomide chemoradiation era. The National Cancer Institute's Surveillance, Epidemiology, and End Results database was queried for patients diagnosed with glioblastoma between 2005 and 2016. Overall survival was assessed using Cox proportional hazard models using disease intrinsic and extrinsic factors. Cause-specific mortality was assessed using cumulative incidence curves and modeled using multivariate cumulative risk regression. A total of 28,952 patients met the prespecified inclusion criteria and were included in this analysis. The following factors were associated with all-cause mortality: age, calendar year of diagnosis, sex, treatment receipt, tumor size, tumor location, extent of resection, median household income, and race. Asian/Pacific Islanders and Hispanic Whites had lower mortality compared to Non-Hispanic Whites. Cause-specific mortality was associated with both racial and socioeconomic groups. After adjusting for treatment and tumor-related factors, Asian/Pacific and black patients had lower glioblastoma-specific mortality. However, lower median household income and black race were associated with significantly higher non-glioblastoma mortality. Despite the aggressive nature of glioblastoma, racial and socioeconomic factors influence glioblastoma-specific and non-glioblastoma associated mortality. Our study shows that patient race has an impact on glioblastoma-associated mortality independently of tumor and treatment related factors. Importantly, socioeconomic and racial differences largely contribute to non-glioblastoma mortality, including death from other cancers, cardio- and cerebrovascular events.

Immune checkpoint inhibitors in advanced nasopharyngeal carcinoma: Beyond an era of chemoradiation?

Now is an exciting era of development in immunotherapy checkpoint inhibitors and their effect on the treatment of NPC. While the general prognosis of R/M disease is poor, immunotherapy offers some promise in a malignancy associated with EBV and characterized by a peritumoural immune infiltrate. Our study aims to review past and on-going clinical trials of monoclonal antibody therapies against the checkpoint inhibitors (e.g. PD1 and CTLA-4), in R/M NPC. All randomized and nonrandomized controlled trials involving immune checkpoint inhibitor interventions for treatment of NPC were included in the study. We utilized a validated "risk of bias" tool to assess study quality. Four separate Phase I-II trials report the potential of PD1 inhibitor treatment for patients with NPC. Within the observed groups, camrelizumab combined with chemotherapy achieved an objective response in 91% of patients as first-line treatment for metastatic NPC (PFS 68% at 1-year) but this was associated with a high rate of grade >3 adverse events (87%; CTCAE version 4.03). The remaining three studies focused on recurrent NPC disease in patients who had received at least one line of prior chemotherapy. Within this group, camrelizumab monotherapy achieved an objective response in 34% of patients (PFS 27% at 1-year; range across all three studies 20.5-34%). No NPC trial has yet reported on specific outcomes for non-PD1 checkpoint inhibitors but 11 on-going studies include alternative targets (e.g. PD-L1/CTLA-4) as combination or monotherapy treatments. In considering checkpoint immunotherapies for NPC, initial results show promise for anti-PD1 interventions. Further phase I-III trials are in progress to clarify clinical outcomes, fully determine safety profiles, and optimize drug combinations and administration schedules.

Adenocarcinoma of the uterine cervix: Pathologic features, treatment options, clinical outcome and prognostic variables.

Adenocarcinoma accounts for 10-25% of all cervical cancers, and its relative and absolute rate has raised over the past decades. Most, but not all the authors, reported that adenocarcinoma has a greater propensity to lymph node, ovarian and distant metastases and a worse prognosis compared with squamous cell carcinoma. However, whether histologic type is an independent prognostic factor is still a debated issue. Moreover, adenocarcinoma is a very heterogenous disease, including different histological subtypes. Whereas radical hysterectomy and definitive radiotherapy achieve the same clinical outcome in early stage squamous cell carcinoma, surgery seems to obtain better survival compared with definitive radiotherapy in early stage adenocarcinoma. Chemoradiation is the standard treatment for locally advanced cervical cancer regardless of histologic type, although several retrospective studies showed that patients with adenocarcinoma were more likely to die than those with squamous cell carcinoma both before and after concurrent chemoradiation era. The prognostic relevance of biological variables, such as cyclin-dependent kinase inhibitors, p53, cyclooxygenase-2 [COX-2], cell surface tyrosine-kinases and programmed death-ligand [PD-L1], is still under investigation. Palliative chemotherapy is the only treatment option for persistent or recurrent cervical adenocarcinoma not amenable with surgery and radiotherapy. The use of immune checkpoint inhibitors as well as a therapeutic strategy targeting cell surface tyrosine kinases should be adequately explored in this clinical setting.

Thrombocytosis is a Prognostic Factor in Women Treated with Chemoradiation for Advanced Cervical Cancer [21A

INTRODUCTION: Prior to the addition of chemotherapy to radiation, thrombocytosis was seen as a poor prognostic factor for women with advanced cervical cancer. The objective of this study was to see in the chemoradiation era whether thrombocytosis was still a prognostic factor. METHODS: An IRB study was performed analyzing all patients with cervical cancer receiving primary chemoradiation as therapy with a diagnosis between January 1, 2001 and December 31, 2011. Minimum follow up was 30 months. Records were examined for initial platelet count at diagnosis, stage, grade, histology and survival. Only patients receiving chemoradiation with stage IIa-Vb cervical cancer were studied included in the final analysis. RESULTS: 209 women with cervical cancer were diagnosed with 173 women treated with primary chemoradiation. The most common stage was IIIb (88, 50.9%). The mean platelet counts of those receiving chemoradiation was significantly higher (396k/ml; 95%CI 376-416k) than those with lower stage disease (313k/ml; 292-334k)(p&lt;0.001). Of the 173 patients, 42 (24.3%) had a platelet count &gt; 450k/ml and 24 (13.9%) had a platelet count &gt;500k/ml. Patients who died of disease had significantly higher initial platelet counts (mean 433k/ml; 95%CI 407-458k) than those who were alive at the completion of follow-up (mean 326k/ml; 95%CI 303-350k). None of the patients with an initial platelet count &gt;500k/ml were alive at the time of follow-up. CONCLUSION: High platelet count at initial diagnosis is a poor prognostic factor in women with cervical cancer treated by chemoradiation.

Neck dissection for unknown cancer of the head and neck in the era of chemoradiation

PurposeTo report outcomes for patients with cervical lymph node metastases from an unknown primary site of the head and neck treated with either non-operative therapy or neck dissection followed by adjuvant therapy. Materials and MethodsAll patients with squamous cell carcinoma of an unknown primary site of the head or neck seen between 2003 and 2013 were reviewed. The Kaplan-Meier method was used to estimate overall survival, local recurrence free survival, loco-regional recurrence free survival, and progression free survival. The log-rank test and proportional hazards regression were used to analyze factors influencing outcomes. ResultsOf 2258 patients with a new diagnosis of head and neck cancer, no primary site was identified in 66 patients. Twenty-nine patients were treated with definitive non-operative therapy (15 with chemoradiation and 14 with radiation alone). Thirty-seven patients received an upfront neck dissection followed by adjuvant radiation or chemoradiation. Three-year loco-regional recurrence free survival, progression free survival, and overall survival were 55.9%, 55.4%, and 69.4% respectively. Patients treated with preoperative neck dissection had improved local recurrence free survival (96.7% vs 54.1%, p=0.003) and loco-regional recurrence free survival (82.2% vs 46.4%, p=0.068) compared to patients treated with definitive chemoradiation with no difference in overall survival (p=0.641). ConclusionsNeck dissection improved local and regional control but not overall survival in patients with unknown primary squamous cell carcinoma of the head and neck over non-operative therapy alone.

The Impact of Radiation Treatment Time on Survival in Patients With Head and Neck Cancer

To assess the impact of radiation treatment time (RTT) in head and neck cancers on overall survival (OS) in the era of chemoradiation. Patients with diagnoses of tongue, hypopharynx, larynx, oropharynx, or tonsil cancer were identified by use of the National Cancer Database. RTT was defined as date of first radiation treatment to date of last radiation treatment. In the definitive setting, prolonged RTT was defined as >56days, accelerated RTT was defined as <47days, and standard RTT was defined as 47 to 56days. In the postoperative setting, prolonged RTT was defined as >49days, accelerated RTT was defined as <40days, and standard RTT was defined as 40 to 49days. We used χ2 tests to identify predictors of RTT. The Kaplan-Meier method was used to compare OS among groups. Cox proportional hazards model was used for OS analysis in patients with known comorbidity status. 19,531 patients were included; 12,987 (67%) had a standard RTT, 4,369 (34%) had an accelerated RTT, and 2,165 (11%) had a prolonged RTT. On multivariable analysis, accelerated RTT (hazard ratio [HR] 0.84; 95% confidence interval [CI] 0.73-0.97) was associated with an improved OS, and prolonged RTT (HR 1.25; 95% CI 1.14-1.37) was associated with a worse OS relative to standard RTT. When the 9,200 (47%) patients receiving definitive concurrent chemoradiation were examined, prolonged RTT (HR 1.29; 95% CI 1.11-1.50) was associated with a worse OS relative to standard RTT, whereas there was no significant association between accelerated RTT and OS (HR 0.76; 95% CI 0.57-1.01). Prolonged RTT is associated with worse OS in patients receiving radiation therapy for head and neck cancer, even in the setting of chemoradiation. Expeditious completion of radiation should continue to be a quality metric for the management of head and neck malignancies.

Squamous Cell Cancer of an Unknown Primary Head and Neck Site: Is Upfront Neck Dissection Still Relevant in the Era of Chemoradiation?

(NPM) is commonly used but often results in incomplete pain control and is associated with its own side effects. Single-institution retrospective reports have provided evidence that prophylactic gabapentin (GP) may reduce the need for NPM in patients undergoing RT, however the ideal dosing schedule is unknown. The purpose of this study was to evaluate whether the use of 300 mg 3 times daily (TID) of GP in a community oncology center will result in reduced need for NPM or reduced weight loss (WL) in patients undergoing RT with or without chemotherapy for oropharyngeal cancer. Materials/Methods: We performed a retrospective chart review of all patients treated with RT for oropharyngeal cancer in our clinic over the last 33 months. From these data, we stratified patients by the use of GP and compared the amount of NPM, the time to initiation of NPM, and the amount of WL between patients who did and did not receive GP. Two-tailed t tests were used to determine significance with a for significance set at P .05. Results: From November 2012 through July 2015, 64 patients with oropharyngeal cancer completed their prescribed RT course and at least 1 month of post-RT follow-up at our institution. Thirty-one patients received GP (at least 300 mg TID) within the first 2 weeks of RT. Patients who received GP had less unintentional WL (9.03 vs 15.82 lbs, PZ.004) and initiated NPM later in their RT course (34.6 vs 22.3 days, P<.001). On subset analysis, patients who underwent upfront surgery and patients with p16-positive disease had less unintentional WL with the use of GP. Oropharyngeal subsite did not influence the effect of GP. No adverse effects were attributed to GP. Conclusion: Patients who initiated at least 300 mg TID of GP within the first 2 weeks of RT for oropharyngeal cancer experienced less WL and a longer time to initiation of NPM compared to those that did not initiate GP. These differences were independent of oropharyngeal subsite. No adverse effects were attributed to GP. Patients who underwent upfront surgery and patients with p16-positive disease derived the greatest benefit from the use of GP. These data support continued exploration of GP use in this patient population. Our institution intends to continue to explore the effect of higher GP dosing in future patients to elucidate potential dose-response relationships. Author Disclosure: T. Dong: None. A. Reed: None. G.C. Jones: None. D. Scoble: None. J. Deeken: None. G.K. Bajaj: None.

Survival Impact of Prolonged Treatment Duration in Primary Chemoradiation for Cervical Cancer

Objective: Prolonged radiation treatment duration has been negatively associated with treatment outcomes in cervical cancer. We soughttoevaluate factors associated with radiation treatment duration and to analyze the impact of prolonged treatment duration on cervical cancer survival outcomes in the era of chemoradiation. Methods:Data for patients undergoing primary radiation for cervical cancer at 2 affiliated teaching institutions from 1999–2008 were retrospectively reviewed. Clinicopathologic and treatment factors were assessed for an association with treatment duration. The impact of treatment duration on disease free (DFS) and overall (OS) survival was analyzed. Results:Median treatment duration for the 129 patients who received external beam radiation therapy (EBRT) and brachytherapy was 72 days. 49 patients (38%) completed treatment within 63 days. In multivariate analysis, extent of EBRT field, timing and type of brachytherapy, treatment site and administrative delays were all predictors of treatment duration. In multivariate analysis, treatment duration greater than 63 days was associated with worse DFS (HR 2.61; 95% CI 1.22–5.56; p=0.013) and OS (HR 7.34; 95% CI 1.68–32.1; p=0.008) in early and locally advanced disease. Mortality increased by 1.3% per day for each day of prolongation of radiation duration. Conclusion:In this retrospective analysis, completion of primary chemoradiation for cervical cancer within 63 days was associated with improved DFS and OS. By focusing on potentially modifiable factors including initiation of brachytherapy during EBRT and the resolution of administrative barriers, it may be possible to improve treatment duration, which may result in better patient outcomes.

Upfront Neck Dissection in the Era of Chemoradiation for Head and Neck Squamous Cell Carcinoma of Unknown Primary Site

Upfront Neck Dissection in the Era of Chemoradiation for Head and Neck Squamous Cell Carcinoma of Unknown Primary Site

A Multi-institutional Study of Lymph Node–Positive Cervical Cancer Patients Treated in the Modern Era of Chemoradiation

A Multi-institutional Study of Lymph Node–Positive Cervical Cancer Patients Treated in the Modern Era of Chemoradiation

Outcomes of Cervical Cancer and Positive Para-aortic Lymph Nodes in the Modern Era of Chemoradiation

Patients with cervical cancer with positive para-aortic lymph nodes have a poor prognosis. Our primary aim was to describe outcomes among this subgroup in the era of modern chemoradiation. Patients with histologically confirmed cervical cancer metastatic to their para-aortic lymph nodes diagnosed between 1998 and 2011 and treated with curative intent were included in this analysis. Surgicopathologic, demographic, and outcome data were collected. Descriptive and survival statistics were generated to evaluate overall survival (OS) and progression-free survival (PFS) and to compare outcomes by treatment. P values were generated using both Wilcoxon and log-rank methods and listed respectively. The median PFS was 19 months. The median OS was 23.4 months. The median PFS for radiation only was 14 months and for chemoradiation was 20 months (P = 0.27 and 0.60, respectively). There was no difference in median OS for the radiation-only group versus chemoradiation. The median OS stratified by stage was 32 months (stage I), 21 months (stage II), 19.4 months (stage III), and 19.8 months (stage IV; P = 0.17 and 0.22). Our study shows a median OS of 23 months, which is less than what was documented in the literature. Despite the use of modern chemoradiation therapy, most of the cohort died within 3 years. The low OS presented in our study highlights the limitations of the current treatment regimens and the need for identification of for more effective therapy.

Prognostic factors in stage 2B–3B cervical cancer in an era of chemoradiation

Prognostic factors in stage 2B–3B cervical cancer in an era of chemoradiation

Completed versus aborted radical hysterectomy for node-positive stage IB cervical cancer in the modern era of chemoradiation therapy

ObjectiveDebate continues about optimal management of patients with node-positive stage I cervical cancer. Our objective was to determine if patient outcomes are affected by radical hysterectomy in the modern era of adjuvant chemoradiation. MethodsCervical cancer patients diagnosed from 2000 to 2008 were identified. Demographics, therapy, clinicopathologic data, progression free survival (PFS), overall survival (OS), total radiation exposure, and grade 3–4 complications were analyzed by student t, Mann–Whitney, Fisher's exact, Kaplan–Meier, and log rank tests. ResultsThis single-institution review evaluated forty-one of 334 (13.4%) patients scheduled to undergo radical hysterectomy that had gross nodal disease diagnosed intraoperatively. 15 underwent aborted radical hysterectomy following lymphadenectomy; the remaining 26 underwent radical hysterectomy and lymphadenectomy. Eleven patients undergoing radical hysterectomy underwent whole pelvic radiation therapy (WPRT) while 8 (30.7%) patients underwent WPRT and postoperative vaginal brachytherapy (BT) for local treatment secondary to close margins. All patients undergoing aborted radical hysterectomy underwent WPRT and BT. With mean follow-up of 42.3months, there were no significant differences in urinary, gastrointestinal, or hematologic complications between groups. When comparing those undergoing radical hysterectomy to aborted radical hysterectomy, there were no significant differences in local recurrence (11.5% vs 26.7%, p=0.39) or distant recurrence (19.2% vs. 33.3%, p=0.45), PFS (74.9months vs 46.8months, p=0.106), or OS (91.8months vs 69.4months, p=0.886). ConclusionsTreatment of patients with early stage cervical cancer and nodal metastasis may be tailored intraoperatively. Completion of radical hysterectomy and lymphadenectomy decreases radiation exposure without apparently compromising safety or outcome in the era of adjuvant chemoradiation.

Surgery Versus Radiation Therapy for Stage IB2 Cervical Carcinoma: A Population-Based Analysis

The objective of the study was to examine outcomes in stage IB2 cervical cancer patients undergoing primary surgery versus radiation. Stage IB2 cervical cancer patients were identified from the Surveillance, Epidemiology and End Results Public-Use Database from 2000 to 2006. Patients were divided into those receiving radiation (radiation first) or surgery (surgery first) as initial treatment. Overall survival was calculated by Kaplan-Meier method and compared using log-rank test. In total, 770 patients were identified with stage IB2 cervical cancer; 369 received radiation, and 401 received surgery initially. The radiation-first group had larger mean tumor size than the surgery-first group (6.0 vs 5.5 cm, respectively; P < 0.0001). The overall survival was longer in the surgery-first group compared with the radiation-first group (72.0 vs 61.4 months, respectively; P < 0.0001). Patients undergoing surgery as initial treatment for stage IB2 cervical cancer appear to have improved outcomes in the current era of chemoradiation; however, given the lack of chemotherapy information, a randomized trial will be necessary to see if these results remain valid.

Clinical outcomes and patterns of severe late toxicity in the era of chemo-radiation for cervical cancer

We present a comprehensive analysis of both therapy-induced severe late toxicity and outcome in a cohort of cervical cancer patients following radiation who were treated according to current guidelines and discuss the methodologic problems of systematically reporting these cases. We introduce a revised concept of reporting treatment failure. The records of 128 cervical cancer patients who received radiation from 2003 to 2008 were reviewed. Thirteen patients (10.2%) developed severe late toxicity. The combination of heavy smoking and cardiovascular diseases was found to be a significant contributing factor (HR 6.55, 95% CI 0.99-43.49, p = 0.048). Thirty patients (23.4%) experienced treatment failure. Of these, 12 (9.4%) were defined to have persistent disease, and 18 (14.0%) developed recurrent disease. Patients with recurrent disease had significantly better survival time (p < 0.001). Compared with the persistence subgroup, they had significantly more often multiple sites of relapse (66.7 vs. 8.3%, p = 0.002) and the sites were more often diagnosed outside the pelvis (70.7 vs. 7.7%, p < 0.001). Early disease stages (OR 4.46, 95% CI 1.87-10.63, p < 0.001) and severe late toxicity (p = 0.037) were found to be significant factors for an improved disease-free survival. A comprehensive depiction of both late therapy-related toxicity and treatment failure requires precise clinical descriptions and analyses of the clinical courses. Our new concept to differentiate treatment failure following radiotherapy in cervical cancer into persistent and recurrent disease permits a clear differentiation between distinct subgroups of patients with regard to prognosis and clinical presentation and will lead to a more precise description of these cases in the future.