2810 - Management of De-Novo Stage IVB Cervical Cancer with Induction Chemotherapy Followed by Definitive Chemoradiation
Presenter(s)
C. Y. Mollings Puentes1, H. Gupta1, L. Colbert1, T. Sims2, P. J. Eifel1, A. Jhingran1, M. M. Joyner1, A. Z. Kesaria1, A. H. Klopp1, L. L. Lin1, and C. R. Weil1; 1Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, 2Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
Purpose/Objective(s): Stage IVB cervical cancer comprises 5-15% of all de-novo presentations with a 5-year survival of less than 20%. The management of IVB patients has historically been very individualized without clear data guiding management. The role of local therapy in de novo stage IVB patients is particularly uncertain, as prospective trials often group newly diagnosed IVB patients together with those who have persistent or recurrent disease following chemoradiation (CRT). Herein we present the outcomes of de novo IVB patients who achieved a complete or near-complete metastatic response after induction chemotherapy and subsequently received curative-intent consolidative CRT.
Materials/Methods: A retrospective review of patients diagnosed with FIGO Stage IVB from 2011-2022 was performed. Clinical and demographic information were extracted from the electronic medical record. Patients who received induction chemotherapy followed by definitive CRT to at least 45 Gray (Gy) and brachytherapy were included for analysis. Kaplan-Meier estimators were used to describe progression-free survival (PFS) and overall survival (OS) from initial diagnosis to the date of event or last follow-up.
Results: A total of 10 women with de-novo FIGO Stage IVB cervical cancer who received induction chemotherapy followed by CRT and brachytherapy were identified. The median age of diagnosis was 50 years (range 35-68), with a median follow-up of 2.7 years (yrs; interquartile range 1.6-3.9). Squamous cell carcinoma was the most common histology (67%, n=6). All patients had pelvic adenopathy, and the majority also had paraaortic involvement (90%, n=9). All patients were oligometastatic at diagnosis, with metastatic sites being predominantly supraclavicular (SCV) nodes (60%, n=6), along with mediastinal nodes, liver, bone, and peritoneum (n=1 each). A median of 6 cycles (range 3-15) were completed before chemoradiation., Median total equivalent doses at 2 Gy (EQD2) after brachytherapy to point A and HR-CTV were 76.7 and 85.1 Gy, respectively. All patients with SCV involvement received 60 Gy to an SCV field. Eight patients had progression, all outside of the high-dose fields, and seven patients died. The 1- and 3-yr PFS were 80% and 30%, respectively, and the 1- and 3-yr OS were 100% and 48%, respectively. Two patients with SCV involvement required no additional treatment after CRT and are still alive 9 and 10 years after treatment.
Conclusion: De novo stage IVB cervical cancer has a very poor prognosis but patients with SCV involvement have the potential to be cured, consistent with prior reports. De novo stage IVB patients deserve focused attention in future prospective trials.