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Abstract
Introduction/Background Systemic chemotherapy as standard of care in recurrent cervical cancer is a palliative treatment approach associated with limited oncologic outcome. As emerging evidence indicates favourable prognosis following radical local treatment strategies for oligometastatic disease recurrence in gynaecologic malignancies, there is a high unmet clinical need to define prognostic implications of surgical metastasectomy in recurrent cervical cancer patients.
Methodology Data of all consecutive patients with cervical cancer with International Federation of Gynaecology and Obstetrics (FIGO) 2018 stages IB-IV, who underwent primary external-beam radiotherapy (EBRT) with concomitant chemotherapy, followed by MRI-based image-guided adaptive brachytherapy (IGABT) between 2015 and 2019 was analysed. Oncologic outcome of disease recurrence patterns, defined according to the European Society for Radiotherapy and Oncology (ESTRO) and the American Society for Radiation Oncology (ASTRO) consensus document, was assessed according to the type of recurrence therapy.
Results Of 54 patients (38.8%) with metachronous disease recurrence, 21 (38.8%) were classified as metastatic and 22 (40.7%) as oligometastatic. Oligometastatic recurrence was associated with both improved progression-free survival after recurrence (PFS2, univariate cox: HR 2.95 [1.23–7.08], p=0.015) and disease-specific survival after recurrence (DSS2, univariate cox: HR 3.28 [1.40–7.70], p=0.006, depicted by log-rank in figure 1, oligometastatic (blue) vs. non-oligometastatic (red) recurrence with 95% confidence intervals) irrespective of type of recurrence therapy. Within the group of oligometastatic patients, an exploratory subgroup analysis of patients undergoing surgical resection +/- adjuvant therapy (n=12) suggested both reduced risk of second disease recurrence (OR 0.15 [0.02–0.92], p=0.02) and improved PFS2 (HR 0.24 [0.06–0.99], p=0.048) as compared to palliative systemic treatment (n=7).
Conclusion A clinically relevant number of cervical cancer recurrences after primary chemo-radiotherapy qualifies as oligometastatic according to the ESTRO-ASTRO consensus document. Patients experiencing oligometastatic recurrence should be carefully considered for potentially curative surgical recurrence therapy approaches.
Disclosures The authors have no conflicts of interest to disclose.
