Shandong Cancer Hospital and Institute Jinan, Shandong
C. Peng, X. Li, W. Tang, Q. Guo, Q. Wu, and P. Xie; Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
Purpose/Objective(s): The consensus on individualized radiotherapy in recurrent/metastatic cervical cancer remains elusive, particularly in the era of targeted/immunotherapy treatments, which introduces more controversy. This study aims to assess the efficacy and safety of radiotherapy as a primary treatment for patients with recurrent/metastatic cervical cancer. Materials/Methods: This retrospective study collected data from April 2018 to January 2022, including patients diagnosed with FIGO (2018) stage IVB or recurrent/metastatic cervical cancer. All participants received first-line chemotherapy and radiotherapy, with or without the addition of targeted/immunotherapy followed by maintenance therapy. Patients were stratified into a radiotherapy group and a non-radiotherapy group. Electronic medical records were utilized to compile patient clinical characteristics, metastasis details, and survival data. The primary study endpoints were overall survival (OS) and progression-free survival (PFS). Survival analysis was performed using the Kaplan-Meier method, with Cox regression analysis identifying independent prognostic factors for OS and PFS. SPSS software and R language were used for data analysis, with a significance threshold set at P < 0.05. Results: This study included 286 patients from six Chinese institutions, with 193 (67.5%) not receiving radiotherapy and 93 (32.5%) undergoing radiotherapy. Among these, 77 patients received targeted/immunotherapy followed by maintenance therapy, with 19 of them also receiving radiotherapy. Within the radiotherapy cohort, 22 patients were treated with brachytherapy alone, and 71 received external beam radiation therapy (EBRT), including 27 targeting distant metastatic sites specifically. The baseline characteristics of both groups were comparable. The integration of radiotherapy markedly improved median progression-free survival (PFS) (21 vs. 12 months; P=0.003). However, the enhancement in overall survival (OS) was not statistically significant (28 vs. 24 months; P=0.303). Notably, within the subgroup receiving targeted/immunotherapy, patients who also underwent radiotherapy showed significantly higher median OS (>50 vs. 34 months; P=0.047) and PFS (27 vs. 17 months; P=0.032) compared to those not receiving targeted/immunotherapy. Cox multivariate analysis identified oligometastasis, concurrent radiotherapy, maintenance therapy, and an extended interval before recurrence as independent predictors of improved PFS. There was an increase in the incidence of treatment-related radiation proctitis and cystitis. Conclusion: In patients with recurrent/metastatic cervical cancer, adding radiotherapy to first-line chemotherapy, especially when combined with targeted/immunotherapy, can improve survival outcomes. Despite the potential increase in treatment-related complications like radiation proctitis and cystitis, these are generally manageable with symptomatic treatment.
