TY - JOUR
T1 - Clinical outcomes after isolated pelvic failure in cervical cancer patients treated with definitive radiation
AU - Lin, Alexander J.
AU - Ma, Sirui
AU - Markovina, Stephanie
AU - Schwarz, Julie
AU - Mutch, David G.
AU - Powell, Matthew A.
AU - Grigsby, Perry W.
N1 - Publisher Copyright:
© 2019 Elsevier Inc.
PY - 2019/6
Y1 - 2019/6
N2 - Purpose: To describe clinical outcomes in patients with isolated pelvic failures after definitive radiation treatment for cervical cancer. Methods and materials: Cervical cancer patients with isolated pelvic failure after definitive radiation with brachytherapy boost were identified in a tertiary academic center database from 1997 to 2016. All patients received an FDG-PET scan prior to their initial treatment and at the time of their first recurrence. Isolated failures in the cervix or pelvic nodes were biopsy-proven. Distant failure and overall survival (OS) were censored outcomes. Results: Isolated pelvic failure was detected in 67(11%) out of 607 consecutive patients treated with external beam pelvic radiation and brachytherapy boost. The median time to isolated pelvic recurrence was 9 months (range 3–198). Median follow-up time for patients alive after isolated pelvic recurrence was 40 months (range 0.6–183). Of these 67 patients, 28(42%) received salvage surgery, 17(25%) received chemotherapy alone, and 22(33%) received neither surgery nor chemotherapy. The median time to distant failure after isolated pelvic failure was 20 months (95% CI 3–37), with no significant difference between patients treated surgically vs. non-surgically. FDG-avid pelvic and para-aortic nodes at initial presentation were associated with worse distant control after isolated pelvic failure (HR = 3.4, 95% CI 1.0–12). Median OS for patients treated with surgery, chemotherapy alone, and neither surgery nor chemotherapy was 29 months (95% CI 16–41), 12 months (95% CI 3–21), and 3 months (95% CI 1–5), respectively. Conclusions: Patients who have pelvic and para-aortic nodal disease at initial presentation are at higher risk of failing distantly after isolated pelvic failure, which should be considered when counseling patients on aggressive surgical salvage. Surgical salvage was associated with prolonged survival after isolated pelvic failure.
AB - Purpose: To describe clinical outcomes in patients with isolated pelvic failures after definitive radiation treatment for cervical cancer. Methods and materials: Cervical cancer patients with isolated pelvic failure after definitive radiation with brachytherapy boost were identified in a tertiary academic center database from 1997 to 2016. All patients received an FDG-PET scan prior to their initial treatment and at the time of their first recurrence. Isolated failures in the cervix or pelvic nodes were biopsy-proven. Distant failure and overall survival (OS) were censored outcomes. Results: Isolated pelvic failure was detected in 67(11%) out of 607 consecutive patients treated with external beam pelvic radiation and brachytherapy boost. The median time to isolated pelvic recurrence was 9 months (range 3–198). Median follow-up time for patients alive after isolated pelvic recurrence was 40 months (range 0.6–183). Of these 67 patients, 28(42%) received salvage surgery, 17(25%) received chemotherapy alone, and 22(33%) received neither surgery nor chemotherapy. The median time to distant failure after isolated pelvic failure was 20 months (95% CI 3–37), with no significant difference between patients treated surgically vs. non-surgically. FDG-avid pelvic and para-aortic nodes at initial presentation were associated with worse distant control after isolated pelvic failure (HR = 3.4, 95% CI 1.0–12). Median OS for patients treated with surgery, chemotherapy alone, and neither surgery nor chemotherapy was 29 months (95% CI 16–41), 12 months (95% CI 3–21), and 3 months (95% CI 1–5), respectively. Conclusions: Patients who have pelvic and para-aortic nodal disease at initial presentation are at higher risk of failing distantly after isolated pelvic failure, which should be considered when counseling patients on aggressive surgical salvage. Surgical salvage was associated with prolonged survival after isolated pelvic failure.
KW - Chemotherapy
KW - Distant control
KW - Patterns of failure
KW - Pelvic exenteration
KW - Radical hysterectomy
KW - Salvage therapy
UR - http://www.scopus.com/inward/record.url?scp=85063088458&partnerID=8YFLogxK
U2 - 10.1016/j.ygyno.2019.03.104
DO - 10.1016/j.ygyno.2019.03.104
M3 - Article
C2 - 30905434
AN - SCOPUS:85063088458
SN - 0090-8258
VL - 153
SP - 530
EP - 534
JO - Gynecologic oncology
JF - Gynecologic oncology
IS - 3
ER -