Salvage (re) radiation in oligometastatic and oligorecurrent cervical cancer
Menée sur la période 2017-2020 auprès de 58 patientes atteintes d'un cancer du col de l'utérus récidivant ou métastatique (durée médiane de suivi : 28 mois), cette étude analyse l'intérêt, pour améliorer la survie, d'ajouter une radiothérapie à la chimiothérapie palliative
Introduction: In patients with recurrent or metastatic cervical cancer, the median survival is 13-24 months based on the choice of palliative systemic chemotherapy. Evolving evidence suggests that the addition of radiation may lead to improved survival. Material and methods: Consecutive patients treated with radiation+/- systemic chemotherapy for oligometastatic or oligo-recurrent disease between 2017-2020 were included. All patients received systemic chemotherapy consultation and radiation to relapsed or metastatic sites. Progression-free survival (PFS) was determined as the period between diagnosis of relapse or metastasis and the last progression of the disease. Overall survival was defined as the time between the date of diagnosis of relapse or metastasis and follow-up or death. The impact of various prognostic and predictive factors was estimated using the Kaplan Meier and log-rank method. Results: Fifty-eight consecutive patients were included. The median time to relapse was 18 months (8-205 months). At the time of first relapse, 34.4% patients (n=20) had locoregional relapse, 32.8% (n=19) patients had distant nodal metastases and 32.8% (n=19) had visceral metastases. The relapse was within previously irradiated portals in 34.5%(n=20), out of field in 50% (n=29), and both in 15.5% (n=9) of patients. Overall, 56%(n=33) of patients received systemic chemotherapy. Radiotherapy dose in equivalent doses of 2 Gy (EQD2Gy) at the time of retreatment was 44 Gy (31- 68 Gy). The median PFS and OS from the date of first relapse were 16 (12-19) and 28 months (2-108). Grade ≥ 3 toxicity was observed in 19% of patients. No patient or treatment-related factor was identified as predictive of OS on univariate analysis. Conclusion: The use of potentially radical doses of radiation, including reirradiation at locoregional or distant oligo-relapse or metastasis, is associated with encouraging PFS and OS in patients with cervical cancer.
International Journal of Radiation Oncology, Biology, Physics