Outcome of stage IVA cervical cancer patients with disease limited to the pelvis in the era of chemoradiation: a Gynecologic Oncology Group study |
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Authors: | Rose Peter G Ali Shamshad Whitney Charles W Lanciano Rachelle Stehman Frederick B |
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Affiliation: | a Gynecologic Oncology, Department of Obstetrics and Gynecology, Cleveland Clinic Foundation and Case Western Reserve University, Cleveland, OH, USAb Gynecologic Oncology Group Statistical and Data Center, Roswell Park Cancer Institute, Buffalo, NY, USAc Christiana Gynecologic Oncology, LLC, Apex Medical Center, Newark, DE, USAd Radiation Oncology, Delaware County Memorial Hospital, Drexel Hill, PA, USAe Gynecologic Oncology, Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, IN, USA |
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Abstract: | ObjectivesTo evaluate the outcome of stage IVA cervical cancer treated with radiation and concurrent cisplatin-based chemotherapy.MethodsWe conducted a retrospective study of stage IVA cervical cancer patients from four trials (Gynecologic Oncology Group protocols 56, 85, 120, and 165) treated with radiotherapy with or without concurrent cisplatin-based chemotherapy. Patient records were reviewed for demographic and tumor features, treatment, and progression-free survival (PFS) and overall survival (OS). Stage IVA patients were compared to stage IIIB patients from these same studies.ResultsAmong the 51 stage IVA patients studied, 92% were stage IVA on the basis of bladder involvement. The median PFS was 10.1 months (95% CI = 6.3-14.5 months) and median OS was 21.2 months (95% CI = 13.3-30.5 months). The 3 year survival was 32%. On univariate analysis, only advanced age was associated with OS (p = 0.0115) but age had only marginal effect on PFS (p = 0.083). Pathologic proven pelvic nodal metastasis was of marginal significance for both PFS and OS, p = 0.059 and 0.064, respectively. Despite similar patient characteristics, the use of cisplatin-based chemotherapy had no impact on PFS or OS but was underpowered to address this question. When compared to stage IIIB patients, stage IVA patients had a poorer performance status (p = 0.0231), larger tumor size (p = 0.0302), and more frequent bilateral parametrial involvement (0.0063).ConclusionPatients with stage IVA disease had poor median survival of only 21 months with only 32% 3 year survival. Stage IVA patients have larger tumor size, more bilateral parametrial involvement, and poorer survival when compared to stage IIIB patients. |
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Keywords: | Stage IVA cervical cancer Hydronephrosis Performance status Survival |
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