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  • Long-term survival in patients with para-aortic metastatic cervical cancer receiving simultaneous integrated boost chemoradiation to positive lymph nodes: a single-center experience

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Long-term survival in patients with para-aortic metastatic cervical cancer receiving simultaneous integrated boost chemoradiation to positive lymph nodes: a single-center experience
  1. Hui Gao1,
  2. Haijing Wu2,
  3. Yue Zhang1,
  4. Xiaokai Li1,
  5. Zhongchun Qi1,
  6. Mingyi Wang3 and
  7. Shuai Wang4
    1. 1Department of Oncology, People's Liberation Army The General Hospital of Western Theater Command, Chengdu, Sichuan, China
    2. 2Department of Gynecological Oncology, Sichuan Cancer Hospital & Institute, Cancer Hospital Affiliated to School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
    3. 3Department of Obstetrics & Gynecology, People's Liberation Army The General Hospital of Western Theater Command, Chengdu, Sichuan, China
    4. 4Outpatient Department, People's Liberation Army The General Hospital of Western Theater Command, Chengdu, Sichuan, China
    1. Correspondence to Dr Hui Gao, Department of Oncology, People's Liberation Army The General Hospital of Western Theater Command, Chengdu, Sichuan, China; gaoh_rad{at}foxmail.com

    Abstract

    Objectives To examine the benefits of extended-field chemoradiation with simultaneous integrated boost to positive lymph nodes, followed by image-guided adaptive brachytherapy in patients with cervical cancer with para-aortic metastasis.

    Methods This retrospective cohort study enrolled 143 patients diagnosed between January 2011 and July 2023 at a single center. Survival and recurrence were evaluated using the Kaplan-Meier method and log-rank test. Cox regression was employed to identify prognostic factors and adjust for confounding factors. Patients were then stratified according to neoadjuvant chemotherapy, and its impact on survival outcomes was evaluated.

    Results A total of 129 patients completed the entire treatment course. The 5-year overall survival rate was 57.6%, and the para-aortic failure rate was 6.8% after a median follow-up of 61 months (95% CI 49 to 82 months). Multivariate analysis indicated that neoadjuvant chemotherapy, larger primary tumor or pelvic/para-aortic lymph nodes, and lower hemoglobin nadir (for widespread metastasis-free survival only) predicted poorer survival. After propensity score matching, the 5-year para-aortic recurrence-free, widespread metastasis-free, and overall survival rates were 92.2% vs 92.8% (p=0.85), 50.8% vs 72.1% (p=0.007), and 47.5% vs 65.5% (p=0.037), respectively, in groups receiving neoadjuvant chemotherapy or not. Sixteen patients (12.4%) experienced grade 3–4 late toxicities. Patients who received neoadjuvant chemotherapy had a significantly higher incidence of grade 3–4 anemia and neutropenia than those who did not (45.2% vs 26.7% and 38.1% vs 21.8%, respectively), if including another 14 patients who discontinued treatment due to acute vomiting.

    Conclusion Chemoradiation with simultaneous integrated boost to positive lymph nodes demonstrates favorable outcomes and acceptable late toxicities in para-aortic metastatic cervical cancer. Neoadjuvant chemotherapy has been shown to adversely affect outcomes, and acute vomiting is a major cause of treatment abortion.

    • Cervical Cancer
    • Uterine Cervical Neoplasms
    • China

    Data availability statement

    Data are available upon reasonable request.

    https://doi.org/10.1136/ijgc-2024-005664

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      Data availability statement

      Data are available upon reasonable request.

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      Footnotes

      • HG and HW contributed equally.

      • Contributors Conceptualization, supervision, and project administration: HG; investigation and writing-original draft preparation: HW; investigation and data curation: YZ; methodology and resources: XL; formal analysis: ZQ; writing-reviewing and editing: MW; validation: SW; final approval of manuscript: all authors. Guarantor: HG.

      • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

      • Competing interests None declared.

      • Provenance and peer review Not commissioned; externally peer reviewed.

      • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.