Adjuvant Chemoradiotherapy in Cervical Cancer and the Impact of Timing and Duration on Treatment Outcome

Publication date: Available online 31 March 2017
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Sachin Jhawar, Lara Hathout, Mohamed A. Elshaikh, Sushil Beriwal, William Small, Omar Mahmoud
PurposeWorse Treatment outcomes are expected with prolongation of overall treatment time (OTT) during definitive chemoradiotherapy of cervical cancer. In the adjuvant setting, data on the relative importance of OTT and the importance of radiotherapy and chemotherapy synchronization are scarce. Using the National Cancer Data Base, we aimed to evaluate the impact of these treatment variables on overall survival in the adjuvant chemoradiotherapy setting.MethodsThe analysis included non-metastatic cervical cancer patients undergoing hysterectomy followed by adjuvant chemoradiotherapy. The proportional hazard model estimated the effect of prognostic factors (age, comorbidity, race, tumor size, grade and histology, number of high risk pathologic factors) and time-related variables (surgery to radiotherapy start interval (SR), OTT (radiotherapy start to end dates), package time (from diagnosis date to CRT end date) and optimum chemoradiotherapy synchronization (if chemotherapy and radiation start date coincided) on survival.ResultsOf the 3051 patients, 60% finished RT within 7 weeks and 85% had optimum chemoradiotherapy. Among other factors, univariate analysis identified longer OTT (hazards ratio (HR): 1.33; p<0.001), longer SR (HR: 1.17; p=0.05) and non-optimum CRT timing (HR: 1.21; p=0.04) as poor prognosticators. Of these factors, SR (HR: 1.20; p=0.04) and OTT (HR: 1.21; p=0.002) retained significance on multivariate analysis. OTT exceeding 7 weeks remained a significant factor even after propensity score matching (p=0.04).ConclusionsOur analysis suggests that prolongation of adjuvant chemoradiotherapy duration beyond 7 weeks is associated with poor survival, and surgery to radiotherapy interval less than 8 weeks should be attempted whenever clinically feasible.

Teaser

In the definitive management of cervical cancer, prolongation of the overall treatment time is associated with poor outcome. Similar evidence is lacking in the adjuvant setting. A large population based database was used to assess the prognostic impact of disease-related as well as time-related/treatment variables on survival. Reducing surgery-to-radiation interval below 8 weeks and chemoradiotherapy duration below 7 weeks was associated with improved survival.


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