Postoperative chemoradiation therapy in high-risk cervical cancer: Re-evaluating the findings of gynecologic oncology group study 109 in a large, population-based cohort

Daniel Trifiletti, Samuel Swisher-Mcclure, Timothy N. Showalter, Sarah E. Hegarty, Surbhi Grover

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Purpose To review the National Cancer Database (NCDB) to evaluate postoperative high-risk cervical cancer patients for factors associated with a benefit from chemoradiation therapy (CRT) over external beam radiation therapy alone (EBRT). Methods and Materials The National Cancer Database was queried for women with cervical cancer treated with hysterectomy and adjuvant EBRT from 2002 to 2012. Only patients with pathologic lymph node involvement (LN+), positive surgical margins, and/or parametrial invasion were included in our analysis (on the basis of Peter's criteria). Univariable and multivariable analyses (MVA) were performed, and hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated to investigate for factors associated with of CRT utilization and overall survival (OS). Results A total of 3053 patients met inclusion criteria, and 2479 received adjuvant CRT (81%), whereas 574 (19%) received EBRT alone. Factors associated with increased CRT utilization on MVA included age <69 years, year of diagnosis ≥2008, non-adenocarcinoma histology, and LN+. Use of CRT improved OS among the entire cohort on MVA (HR 0.76, CI 0.601-0.962; P=.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=.002). Chemoradiation therapy did not improve OS in patients with only positive margins (P=.73), only parametrial invasion (P=.95), or any combination of these 2 factors without LN+ (P=.63). Conclusions The use of adjuvant CRT after hysterectomy improves OS in patients with high-risk cervical cancer compared with EBRT alone, but this benefit seems 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.

Original languageEnglish (US)
Pages (from-to)1032-1044
Number of pages13
JournalInternational Journal of Radiation Oncology Biology Physics
Volume93
Issue number5
DOIs
StatePublished - Dec 1 2015
Externally publishedYes

Fingerprint

Uterine Cervical Neoplasms
therapy
cancer
radiation therapy
Population
Radiotherapy
Survival
hazards
confidence
margins
Therapeutics
Confidence Intervals
intervals
Hysterectomy
Databases
histology
lymphatic system
Neoplasms
Histology
Lymph Nodes

ASJC Scopus subject areas

  • Radiation
  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Cancer Research

Cite this

Postoperative chemoradiation therapy in high-risk cervical cancer : Re-evaluating the findings of gynecologic oncology group study 109 in a large, population-based cohort. / Trifiletti, Daniel; Swisher-Mcclure, Samuel; Showalter, Timothy N.; Hegarty, Sarah E.; Grover, Surbhi.

In: International Journal of Radiation Oncology Biology Physics, Vol. 93, No. 5, 01.12.2015, p. 1032-1044.

Research output: Contribution to journalArticle

@article{3af7f7200dc14e6dac7b806717e86aa7,
title = "Postoperative chemoradiation therapy in high-risk cervical cancer: Re-evaluating the findings of gynecologic oncology group study 109 in a large, population-based cohort",
abstract = "Purpose To review the National Cancer Database (NCDB) to evaluate postoperative high-risk cervical cancer patients for factors associated with a benefit from chemoradiation therapy (CRT) over external beam radiation therapy alone (EBRT). Methods and Materials The National Cancer Database was queried for women with cervical cancer treated with hysterectomy and adjuvant EBRT from 2002 to 2012. Only patients with pathologic lymph node involvement (LN+), positive surgical margins, and/or parametrial invasion were included in our analysis (on the basis of Peter's criteria). Univariable and multivariable analyses (MVA) were performed, and hazard ratios (HRs) with 95{\%} confidence intervals (CIs) were calculated to investigate for factors associated with of CRT utilization and overall survival (OS). Results A total of 3053 patients met inclusion criteria, and 2479 received adjuvant CRT (81{\%}), whereas 574 (19{\%}) received EBRT alone. Factors associated with increased CRT utilization on MVA included age <69 years, year of diagnosis ≥2008, non-adenocarcinoma histology, and LN+. Use of CRT improved OS among the entire cohort on MVA (HR 0.76, CI 0.601-0.962; P=.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=.002). Chemoradiation therapy did not improve OS in patients with only positive margins (P=.73), only parametrial invasion (P=.95), or any combination of these 2 factors without LN+ (P=.63). Conclusions The use of adjuvant CRT after hysterectomy improves OS in patients with high-risk cervical cancer compared with EBRT alone, but this benefit seems 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.",
author = "Daniel Trifiletti and Samuel Swisher-Mcclure and Showalter, {Timothy N.} and Hegarty, {Sarah E.} and Surbhi Grover",
year = "2015",
month = "12",
day = "1",
doi = "10.1016/j.ijrobp.2015.09.001",
language = "English (US)",
volume = "93",
pages = "1032--1044",
journal = "International Journal of Radiation Oncology Biology Physics",
issn = "0360-3016",
publisher = "Elsevier Inc.",
number = "5",

}

TY - JOUR

T1 - Postoperative chemoradiation therapy in high-risk cervical cancer

T2 - Re-evaluating the findings of gynecologic oncology group study 109 in a large, population-based cohort

AU - Trifiletti, Daniel

AU - Swisher-Mcclure, Samuel

AU - Showalter, Timothy N.

AU - Hegarty, Sarah E.

AU - Grover, Surbhi

PY - 2015/12/1

Y1 - 2015/12/1

N2 - Purpose To review the National Cancer Database (NCDB) to evaluate postoperative high-risk cervical cancer patients for factors associated with a benefit from chemoradiation therapy (CRT) over external beam radiation therapy alone (EBRT). Methods and Materials The National Cancer Database was queried for women with cervical cancer treated with hysterectomy and adjuvant EBRT from 2002 to 2012. Only patients with pathologic lymph node involvement (LN+), positive surgical margins, and/or parametrial invasion were included in our analysis (on the basis of Peter's criteria). Univariable and multivariable analyses (MVA) were performed, and hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated to investigate for factors associated with of CRT utilization and overall survival (OS). Results A total of 3053 patients met inclusion criteria, and 2479 received adjuvant CRT (81%), whereas 574 (19%) received EBRT alone. Factors associated with increased CRT utilization on MVA included age <69 years, year of diagnosis ≥2008, non-adenocarcinoma histology, and LN+. Use of CRT improved OS among the entire cohort on MVA (HR 0.76, CI 0.601-0.962; P=.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=.002). Chemoradiation therapy did not improve OS in patients with only positive margins (P=.73), only parametrial invasion (P=.95), or any combination of these 2 factors without LN+ (P=.63). Conclusions The use of adjuvant CRT after hysterectomy improves OS in patients with high-risk cervical cancer compared with EBRT alone, but this benefit seems 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.

AB - Purpose To review the National Cancer Database (NCDB) to evaluate postoperative high-risk cervical cancer patients for factors associated with a benefit from chemoradiation therapy (CRT) over external beam radiation therapy alone (EBRT). Methods and Materials The National Cancer Database was queried for women with cervical cancer treated with hysterectomy and adjuvant EBRT from 2002 to 2012. Only patients with pathologic lymph node involvement (LN+), positive surgical margins, and/or parametrial invasion were included in our analysis (on the basis of Peter's criteria). Univariable and multivariable analyses (MVA) were performed, and hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated to investigate for factors associated with of CRT utilization and overall survival (OS). Results A total of 3053 patients met inclusion criteria, and 2479 received adjuvant CRT (81%), whereas 574 (19%) received EBRT alone. Factors associated with increased CRT utilization on MVA included age <69 years, year of diagnosis ≥2008, non-adenocarcinoma histology, and LN+. Use of CRT improved OS among the entire cohort on MVA (HR 0.76, CI 0.601-0.962; P=.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=.002). Chemoradiation therapy did not improve OS in patients with only positive margins (P=.73), only parametrial invasion (P=.95), or any combination of these 2 factors without LN+ (P=.63). Conclusions The use of adjuvant CRT after hysterectomy improves OS in patients with high-risk cervical cancer compared with EBRT alone, but this benefit seems 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.

UR - http://www.scopus.com/inward/record.url?scp=84946781259&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84946781259&partnerID=8YFLogxK

U2 - 10.1016/j.ijrobp.2015.09.001

DO - 10.1016/j.ijrobp.2015.09.001

M3 - Article

C2 - 26581141

AN - SCOPUS:84946781259

VL - 93

SP - 1032

EP - 1044

JO - International Journal of Radiation Oncology Biology Physics

JF - International Journal of Radiation Oncology Biology Physics

SN - 0360-3016

IS - 5

ER -