Definitive Local Therapy is Associated with Improved Overall Survival in Metastatic Cervical Cancer

Publication date: Available online 26 May 2018
Source:Practical Radiation Oncology
Author(s): Sriram Venigalla, David M. Guttmann, Zachary D. Horne, Ruben Carmona, Jacob E. Shabason, Sushil Beriwal
PurposeDefinitive local therapy is often used in metastatic cervical cancer to reduce morbidity associated with local tumor progression. However, the potential benefit of this therapeutic approach has not been rigorously investigated. We hypothesized that definitive local therapy would be associated with improved overall survival (OS) in metastatic cervical cancer.Methods and MaterialsPatients ≥18 years with newly diagnosed metastatic cervical cancer treated with chemotherapy were identified from the National Cancer Database. Patients were dichotomized into the following cohorts¹: definitive local therapy, defined as either concurrent chemoradiotherapy or definitive surgery, or² conservative therapy, defined as systemic therapy with or without palliative radiotherapy. The association between definitive local therapy and OS was assessed using propensity score-weighted Cox proportional hazards models. Potential unmeasured confounding was assessed through sensitivity analyses. Factors associated with receipt of definitive local therapy were identified with multivariable logistic regression.ResultsOf 2,838 total patients, 1,194 (42%) and 1,644 (58%) were treated with definitive local therapy and conservative therapy, respectively. Receipt of definitive local therapy was statistically significantly associated with less comorbidity, lower clinical T stage, and node negative disease. Compared to conservative therapy, definitive local therapy was associated with improved OS (HR=0.57, 95% CI: 0.52-0.62, p ≤ 0.001). Median OS was 19.2 months in the definitive local therapy cohort and 10.1 months in the conservative therapy cohort. These findings were robust to potential unmeasured confounding in sensitivity analyses and on landmark analyses of patients surviving at least 12 months (HR=0.71, 95% CI: 0.62 – 0.82, p ≤ 0.001).ConclusionsDefinitive local therapy is associated with improved OS in patients with metastatic cervical cancer. These findings suggest a novel setting for the use of definitive local therapy in the metastatic setting.



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