Whole Pelvic Radiation May Improve Survival in Advanced Cervical Cancer

Treating women with stage IVB cervical cancer with whole pelvic radiation (WPR) along with standard chemotherapy improved survival over chemotherapy alone in a retrospective study.

As many as 5% of the almost 13,000 cervical cancers each year in the United States present as stage IVB disease, and the 5-year survival for those patients is only 15%. Though management of these patients varies, chemotherapy with platinum and a taxane, with or without bevacizumab, is a mainstay, said Victoria Perkins, MD, of the University of Oklahoma Health Sciences Center.

Perkins said that WPR is used in practice, but its efficacy has not been well studied; it is thought to relieve symptoms and decrease local recurrences in women with stage IVB cervical cancer. She presented results of a retrospective analysis comparing chemotherapy alone to chemotherapy plus WPR at the Society of Gynecologic Oncology (SGO) Annual Meeting, held March 12–15 in National Harbor, Maryland.

A total of 62 patients were treated with chemotherapy alone, and 34 also received WPR. The two groups were similar in age (51 in chemotherapy alone, 55 with WPR; P = .68), race, histology, and disease grade at presentation. Disease location at diagnosis was also similar, and the groups received similar chemotherapy regimens. Bevacizumab, however, was more commonly used in the chemotherapy alone patients (26% vs 12%; P = .01), which Perkins said likely reflects a change in treatment approaches during the study period.

The WPR-treated patients had a median progression-free survival of 10 months, compared with 5 months without it (P = .01). Median overall survival was also improved, at 14.1 months vs 6.9 months with chemotherapy alone (P < .01).

Pelvic-related morbidity was no different between the groups. This included ureteral obstruction, vaginal/rectal bleeding, pelvic infection, pelvic pain, and fistula.

“Survival is extremely poor in stage IVB cervical cancer, but these data indicate there may be utility for WPR without increasing morbidity,” Perkins noted in her presentation. The study is limited, though, by its small size and retrospective design; this could have introduced selection bias, and the treatment regimens received were not standardized. A prospective study is needed to confirm the findings, Perkins said.