Is age a prognostic biomarker for survival among women with locally advanced cervical cancer treated with chemoradiation? An NRG Oncology/Gynecologic Oncology Group ancillary data analysis

Abstract

Objective To determine the effect of age on completion of and toxicities following treatment of local regionally advanced cervical cancer (LACC) on Gynecologic Oncology Group (GOG) Phase I–III trials. Methods An ancillary data analysis of GOG protocols 113, 120, 165, 219 data was performed. Wilcoxon, Pearson, and Kruskal-Wallis tests were used for univariate and multivariate analysis. Log rank tests were used to compare survival lengths. Results One-thousand-three-hundred-nineteen women were included; 60.7% were Caucasian, 15% were age 60–70 years and an additional 5% were >70; 87% had squamous histology, 55% had stage IIB disease and 34% had IIIB disease. Performance status declined with age (p = 0.006). Histology and tumor stage did not significantly differ. Number of cycles of chemotherapy received, radiation treatment time, nor dose modifications varied with age. Notably, radiation protocol deviations and failure to complete brachytherapy (BT) did increase with age (p = 0.022 and p < 0.001 respectively). Only all grade lymphatic (p = 0.006) and grade ≥3 cardiovascular toxicities (p= 0.019) were found to vary with age. A 2% increase in the risk of death for every year increase >50 for all-cause mortality (HR 1.02; 95% CI, 1.01–1.04) was found, but no association between age and disease specific mortality was found. Conclusion This represents a large analysis of patients treated for LACC with chemo/radiation, approximately 20% of whom were >60 years of age. Older patients, had higher rates of incomplete brachytherapy which is not explained by collected toxicity data. Age did not adversely impact completion of chemotherapy and radiation or toxicities.

Increasing age predicts poor cervical cancer prognosis with subsequent effect on treatment and overall survival

“…Either way, it supports our belief that palliative brachytherapy for metastatic cervical cancer is an option for a significant group of women and that even within our study population, there were most likely many more than 3% of women who could have received and benefitted from brachytherapy. Furthermore, the literature has demonstrated repeatedly that brachytherapy is a well-tolerated procedure, even in elderly patients, and that they have no increased rates of toxicity as compared to their younger counterparts 9; 13; 32; 33; 34 . Given a survival advantage for those who did actually receive it, we would strongly encourage providers to include brachytherapy in their palliative regimens, even if this means helping the patient seek care outside of their respective facilities at a high-volume brachytherapy center.…”

Management for locally advanced cervical cancer: new trends and controversial issues

“…Sharma et al [75] reported declining BT use with age in the SEER database, from 66.7% in those <50 years to 58.9% in those 70-79 years and 46.3% in women >70 years of age. There were no significant differences in toxicities by age, except for any grade of lymphatic disorders, which were more common with increasing age [74]. Therefore, old age is not a contraindication of standard treatment for LACC.…”

“…Aging patients (older populations) were defined as those aged 65 years or older. Moore et al [74] analyzed cervical cancer patients treated with primary CCRT on GOG protocols (GOG 113, GOG 120, GOG 165, and GOG 219) stratified by decade of age. The age groups were compared for CCRT tolerance and completion.…”

Underutilization of brachytherapy and disparities in survival for patients with cervical cancer in California

“…In our investigation, the population less likely to be treated with BT are the elderly N80 years old. Moore et al recently performed an ancillary data review of the cooperative oncology group studies of GOG protocols 113, 120, 165 and 219 that examined chemoradiation and BT with data stratified by decade of age with a goal of evaluating patients ≥65 [15]. They found that BT was not completed in 35% of patients ≥ 70 as compared to 13% of pts b 40 on these clinical trials, where patients are often treated in large academic centers with radiation specific brachytherapy and gynecologic programs [15].…”