Introduction/Background In the Netherlands, approximately one third of the cervical cancer patients is diagnosed with locally advanced cervical cancer (LACC). In the past decades, chemoradiation (CRT) has replaced radiotherapy (RT) as preferred treatment. Alternatively, radiotherapy with hyperthermia and radical hysterectomy ± neoadjuvant chemotherapy (RH) are applied in LACC treatment as well. We aimed to evaluate trends in guideline adherence and survival since the introduction of CRT as standard of treatment for LACC in the national guidelines of 2004.
Methodology In this retrospective study, patients diagnosed with cervical cancer (FIGO stages IB2, IIA2-IVA 2009) between 2005–2016, were identified from the Netherlands Cancer Registry. Patients were classified guideline-adherent when receiving primary treatment according to the guideline. Trends, from 2005–2007 to 2014–2016, were analysed with the Cochran-Armitage trend test and 5-year relative survival (RS) was calculated. Multivariable Poisson regression was applied. Subanalyses for FIGO IB2 (only stage for which all treatment modalities apply) and IIB (most prevalent stage) were conducted.
Results 2915 patients (mean age 57±17 years) were diagnosed with LACC - mainly with FIGO IIB (47%). Guideline adherence was observed in 73% of all patients, with higher RS compared to non-adherent patients (see table 1). Over time, increases were seen in guideline adherence and 5-year RS (see figure 1) and CRT was administered more often (73%–86%). Of the 532 IB2 patients, guideline adherence was observed in 86%, CRT was the most common treatment (58%) and those treated with RH (n=173) showed highest survival (82%). Of the 1371 IIB patients, guideline adherence was observed in 79%, CRT was the most common treatment (86%) and those treated with RH (n=43) showed highest survival (84%).
Conclusion Guideline adherence is associated with higher survival. This may partly be explained by confounding by indication. Expectedly, survival rates improved with the replacement of RT by CRT.
Disclosure None of the authors received financial support for the research and/or authorship of this article. Hans Wenzel - Nothing to disclose; Ruud Bekkers - Research funds from Roche Diagnostics; Hans Nijman - Grants from Dutch Cancer Society; Collaborations with Aduro, DCprime, MSD, TRON; Founder of ViciniVax; Valery Lemmens - Unrestricted research grants and educational grants from Roche; Maaike van der Aa - Nothing to disclose.
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