Outcomes and patterns of relapse after definitive radiation therapy for oligometastatic cervical cancer
Introduction
The primary treatment modality for locoregionally advanced cervical cancer is radiation therapy (RT) concurrent with chemotherapy, which can produce cures in approximately 80% of women with local disease and 60% of women with regional disease [1]. Unfortunately, many patients with regional cervical cancer will develop metastatic disease, usually within the first 2 years after treatment. For these women, systemic chemotherapy is considered the standard of care, but durable response rates are low, with median survival times < 1 to 2 years [2], [3], [4]. A subset of these patients, however, have oligometastatic disease involving a limited number of distant regions, with the potential for disease control and prolonged survival after definitive RT to these sites.
Definitive RT to limited sites of metastatic disease has shown success in other malignancies. For example, stereotactic body radiation therapy (SBRT) can be effective in treating oligometastatic melanoma [5], and definitive RT for patients with breast cancer with a limited number of metastatic lesions may also yield prolonged survival [6]. For patients with non-small cell lung cancer and limited numbers of metastatic sites after systemic therapy, randomized controlled data exist demonstrating improved progression-free survival (PFS) after definitive RT [7].
Although evidence supporting the use of definitive RT for oligometastases continues to grow, the utility of this approach for patients with gynecologic malignancies has yet to be explored in depth. The aim of this study was to evaluate the outcomes of patients treated definitively for oligometastatic cervical cancer, and to identify clinical features that are associated with favorable outcomes.
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Patients
We retrospectively studied 38 patients who received definitive treatment for oligometastatic cervical cancer at a single institution between January 2002 and December 2015. Patients were included if they had metastatic disease involving ≤ 2 extra-pelvic/para-aortic sites, including supraclavicular (SCV) lymph nodes, mediastinal lymph nodes, or lung. Patients were included in this study if their oligometastatic disease was diagnosed at the time of their initial cervical cancer diagnosis or during
Patients
The median follow-up time for the entire group of 38 patients was 35.2 months (range 3.1–94.7 months) following completion of RT for oligometastatic disease; clinical and demographic variables are summarized in Table 1. Nine patients were treated for oligometastatic SCV nodal disease diagnosed at the time of their initial cervical cancer presentation. The other 29 patients were treated for asymptomatic metastatic recurrences diagnosed at a median of 15 months (range 2.4–102 months) after treatment
Discussion
This study of definitive RT for oligometastatic cervical cancer demonstrates that: (a) favorable outcomes can be obtained, with our study demonstrating median OS > 50 months and 2-year OS > 70%; (b) local control of treated sites was excellent (97%), though half of patients experienced regional or distal progression at a median 2 years after RT; and (c) RT-related toxicity attributed to oligometastatic sites was minimal, with incidence of grade ≥ 3 toxicity < less than 3%.
The diagnosis of metastatic
Conflicts of interest
Michael Frumovitz receives honorarium and research funding from Novadaq and research funding from Navidea.
Funding
Supported in part by Cancer Center Support (Core) Grant CA016672 from the National Institute of Cancer, National Institutes of Health, to The University of Texas MD Anderson Cancer Center.
Acknowledgments
We extend gratitude towards Christine F. Wogan of MD Anderson's Division of Radiation Oncology for her valuable assistance in editing this manuscript.
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