Predicting the Necessity of Adding Catheters to Intracavitary Brachytherapy for Women Undergoing Definitive Chemoradiation for Cervical Cancer

Abstract

The median follow up was 40 months. At the time of analysis, 2547 were alive, 560 dead and 253 deaths were disease related. Histology and treatment information is presented in the table below. The 5-yr DSS for all patients was 89%. Women with grade 1,2,3, and undifferentiated tumors who were treated with RT had a 5-yr DSS of 87%, 86%, 64% and 70% compared to 80%, 76%, 50%, 43% in those without RT (P < 0.001) respectively. When comparing external be external beam radiation therapy (EBRT) vs. brachytherapy (brachy), there was no difference in DSS in patients across all grades. Among the 2313 patients who had a lymph node (LN) assessment, our results show improved DSS in patients with some form of LN assessment particularly in patients with higher-grade tumors treated with RT. The 5-yr DSS in patients with grade 2 and 3 tumors with no LNs assessed, treated with radiation was 90% and 73% compared to the non-RT group 84% and 45% (P Z 0.0015 and P< 0.001) respectively. Women older than 70 had worse DSS, than younger women, but those with higher-grade tumors who received RT showed improvement in DSS. The 5-yr DSS for those over 70 with grade 2 and 3 tumors treated with RT was 89% and 79% compared to 79% and 63% in the non-RT group (P < 0.001 and P Z 0.07), respectively. Moreover, the DSS rates were similar with either brachy or EBRT. Conclusion: RT improves DSS in FIGO stage II patients with grade 2 or higher tumors and survival outcomes appear equivalent regardless of the modality of radiation therapy. RT improves DSS in patients with limited LN or no LN assessment. Patients older than 70 have a worse outcome, than younger patients, but have a DSS benefit when treated with radiation.