In addition to improving disease-free survival (DFS), chemoradiotherapy (CRT) resulted in an overall survival (OS) benefit for patients with stage IIIB cervical cancer, according to long-term follow-up results of a phase 3 study.1

According to the investigators, the data “reinforce the evidence that CRT for the treatment of stage IIIB (International Federation of Gynecology and Obstetrics 2009) squamous cell carcinoma of the uterine cervix is associated with significantly improved” survival outcomes compared with RT alone.

A total of 146 women with stage IIIB disease were randomly assigned to CRT or RT alone. Results from the primary analysis, obtained at 42.3 months of follow-up, showed significantly improved DFS with the combination therapy vs RT alone; however, patients in the CRT group did not have significantly better OS. This analysis assessed survival outcomes at up to 14 years of follow-up in women who participated in the initial evaluation.

Updated results at a mean follow-up of 62.88 months showed that treatment with RT alone resulted in significantly worse OS (HR, 1.88; 95% CI, 1.09-3.24) and DFS (HR, 1.82; 95% CI, 1.07-3.08) compared with CRT.


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The researchers conducted a multivariate analysis and found that those patients with baseline Karnofsky performance status less than 90% also had significantly worse OS (HR, 3.11; 95% CI, 1.78-5.43) and DFS (HR, 2.83; 95% CI, 1.60-5.01). OS (HR, 4.32; 95% CI, 2.23-8.36) and DFS (HR, 4.16; 95% CI, 2.17-7.95) were found to be markedly worse for patients with hemoglobin less than 10 mg/dL. These results indicate that the optimal status for women receiving CRT is baseline hemoglobin of 10 mg/dL or higher and a performance score of 90% or greater.

“CRT may improve prognosis in this patient population, but it remains necessary to consider adjuvant treatment options for patients with more advanced disease,” the researchers noted. “The use of consolidation chemotherapy after cisplatin-based CRT was recently shown to result in longer overall survival and progression-free survival, mostly attributable to control of distant relapses.”

Reference

 Fachini AMD, Zuliani AC, Sarian LO, et al. Long-term outcomes of concomitant cisplatin plus radiotherapy versus radiotherapy alone in patients with stage IIIB squamous cervical cancer: a randomized controlled trial. Gynecol Oncol. Published online December 16, 2020. doi:10.1016/j.ygyno.2020.11.029