Postoperative chemoradiotherapy in high-risk cervical cancer: reevaluating the findings of GOG 109 in a large, population-based cohort
Menée à partir des données du registre national des cancers portant sur 3 053 patientes atteintes d'un cancer du col de l'utérus à haut risque de récidive et traitées par hystérectomie radicale, cette étude américaine évalue, du point de vue de la survie globale et par rapport à une radiothérapie seule, l'intérêt d'une chimioradiothérapie adjuvante, puis identifie les facteurs associés à son utilisation
Purpose/Objectives : Phase III data supports the use of adjuvant concurrent chemoradiotherapy (CRT) in patients with high-risk cervical cancer following radical hysterectomy, but the criteria for defining high-risk disease remain debatable. Specifically, the benefit of combination therapy among node negative patients is unclear. Our objective was to review the National Cancer Database (NCDB) to evaluate high-risk cervical cancer patients for factors associated with a benefit from CRT over external beam radiotherapy alone (EBRT). Methods and Materials : The NCDB was queried for women with cervical cancer treated with hysterectomy and adjuvant EBRT from 2002-2012. Only patients with pathologic lymph node involvement (LN+), positive surgical margins, and/or parametrial invasion were included in our analysis (based on Peter’s criteria). Univariable (UVA) and multivariable analyses (MVA) were performed, and hazard ratios (HR) with 95% confidence intervals (CI) were calculated to investigate for factors associated with of CRT utilization and overall survival (OS). Results : 3,053 patients met inclusion criteria and 2,479 received adjuvant CRT (81%), whereas 574 (19%) received EBRT alone. Factors associated with increased CRT utilization on MVA included age <69, year of diagnosis ≥2008, non-adenocarcinoma histology, and LN+. CRT use improved OS among the entire cohort on MVA (HR 0.76, CI 0.601-0.962; p=0.022). On MVA, CRT improved OS in patients with LN+ as their sole Peter’s Criteria (HR 0.58, CI 0.413-0.814; p=0.002). CRT did not improve OS in patients with only positive margins (p=0.73), only parametrial invasion (p=0.95), or any combination of these two factors without LN+ (p=0.63). Conclusions : The use of adjuvant CRT after hysterectomy improves OS in patients with high-risk cervical cancer compared to EBRT alone, but this benefit appears to be restricted to patients with LN+. The benefits of adjuvant CRT over EBRT alone in patients with parametrial invasion and/or positive margins (without nodal involvement) are unknown.