Introduction/Background According to ESGO guidelines, chemoradiation without nodal debulking is standard of care for patients with (locally) advanced cervical cancer (LACC). In some centers, for selected cases induction chemotherapy followed by radiotherapy and hyperthermia is offered. In other centres lymph node debulking is performed prior to chemoradiation. These different approaches have not been compared directly in prospective clinical trials.
Methodology This is a retrospective observational study to investigate the overall survival (OS) and progression-free survival (PFS) using the Cox-proportional hazards model in women who underwent either upfront chemotherapy followed by radiotherapy and hyperthermia (triple therapy, TT) or chemoradiotherapy (either with, i.e. CRTN, or without prior, i.e. CRTO, lymph node debulking) for advanced stage cervical cancer in the Netherlands.
Results A total of 373 patients were included: 213 (57%) in the CRTO group, 66 (17.6%) in the CRTN group and 94 (25.2%) in the TT group. Mean age was 50.14 (SD 13.95) years. The mean tumour size was 61.98 (SD 16.72) mm.
Squamous cell carcinoma (91.4%) was the most frequent histological type. According to FIGO 2009 stage, following groups were observed: 15.5% IB2, 18.3% IIA, 31.6% IIB, 7.2% IIIA, 21.4% IIIB, 5.6% IV. According to treatment group, the five-year overall survival rate was 46% for in the CRTN group and 54% for the TT and CRTO group (p=0.479). The five-year PFS was 64% for the TT group, 53% for the CRTO group and 38% for the CRTN group (p=0.054). Cox proportional hazards analysis could identify FIGO stage as significant covariate.
Conclusion Overall survival results were similar between groups (p=0.479). Our data suggests an improvement in PFS for TT in comparison to CRTN (p=0.014). This could, however, be explained by the heterogenous study population and retrospective nature of the data.
Randomised controlled trials to further investigate potentially beneficial treatment options for LACC are warranted.
Disclosures Coordinating investigator (Erasmus MC) Dr H.J. van Beekhuizen
Coordinating investigator (Amsterdam UMC) Dr. C.H. Mom
Coordinating investigator (NKR) Dr M.A. Van der Aa
Principal investigator Drs J. Servayge
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