Objectives The use of consolidation chemotherapy (CCT) after chemoradiation (CRT) in cervical cancer remains debatable. We evaluated the impact of CCT added to up-to-date CRT (CRT) and sought to identify predictive factors of CCT benefit.

Methods This retrospective study reviewed 216 patients with 2014 FIGO stage IB2-IIA2, and IIB-IVB (para-aortic nodes only) cervical cancer treated with CRT alone or CRTT followed by CCT (CCT group). Firstly, we assessed the prognostic role of CCT. Moreover, we developed a prognostic score for distant metastasis free survival (DMFS).

Results After 42.8 months of median follow up 174 patients were treated with standard CRT and 72 with CCT. Clinical characteristics were comparable between groups, except CCT patients were younger (p<0.001) and less frequently treated with 3D radiation techniques (81.4% vs 93.1%, p=0.023). Median survivals were not reached in both groups. In multivariate analyses, CCT was related to longer overall survival (OS) (HR 0.35, p=0.023), progression free survival (HR 0.41, p=0.005) and DMFS (HR 0.40, p=0.010) but not locoregional control.Potential negative factors for DMFS included lymph node status, adenocarcinoma histology, and stage III or IV and formed a four-tier score (0 to 3 points) with good discrimination (p<0.001) (p=0.001). CCT was associated with longer OS (p=0.014) and DMFS (p=0.023) among patients with a score >1 but not for patients with score ≤1 (OS: p=0.310; DMFS: p=0.179).

Conclusions A clinical score may predict CCT benefit. If this score withstands external validation, it may contribute to better selection for CCT.