Presenter(s)
R. Maeda1, L. Rauh-Benoit2, L. Beffa2, M. Kuznicki2, and S. R. Amarnath3; 1Cleveland Clinic Lerner College of Medicine, Cleveland, OH, 2Department of Gynecologic Oncology, Cleveland Clinic Foundation, Cleveland, OH, 3Department of Radiation Oncology, Cleveland Clinic Foundation, Cleveland, OH
Purpose/Objective(s): Cervical cancer incidence is increasing among geriatric patients, who often are medically complex and underrepresented in clinical trials, making medical decisions challenging in this population. We evaluated treatment patterns and clinical outcomes in patients =65 years with cervical cancer.
Materials/Methods: We conducted a retrospective cohort study of patients aged =65 years diagnosed with cervical cancer between January 1, 2013 and December 31, 2022 at a multi-center academic healthcare system. Demographics, disease characteristics, treatments, outcomes, and late toxicities were abstracted by chart review. Late treatment-related toxicities were defined as Common Terminology Criteria for Adverse Events (CTCAE) Grade 3–4 events occurring =3 months post-treatment. Late radiation-related toxicities were defined as CTCAE Grade 1–2 events =3 months post-treatment attributed to radiation. Descriptive statistics and survival analyses were performed.
Results: Eighty-three patients met inclusion criteria (median age 75, range 65–93; 22% =80 years). Disease stage was localized (IA1-IB3) in 23 patients (28%), regional (IIA1-IVA) in 48 patients (58%), and distant (IVB) in 12 patients (14%). Histology was predominantly squamous cell carcinoma (72%), with 79% of tumors being HPV-associated. Definitive therapy was delivered in 67 patients (81%), palliative therapy in 14 patients (17%), and no treatment for 2 patients (2%). Treatments included surgery (n=24, 29%), chemotherapy (n=57, 69%; median 5 cycles), and EBRT (n=66, 80%), with 42 patients (64%) receiving brachytherapy. Immunotherapy was administered in 6 patients (7%). Median follow-up time was 46.6 months with median OS of 104.7 months (localized), 51.4 months (regional), and 16.2 months (distant). Median PFS was 104.7, 40.9, and 9.9 months, respectively. 2-year OS/PFS by treatment was 0%/0% for no treatment, 33%/0% for chemotherapy alone, 13%/0% for radiation alone, 78%/69% for ChemoRT, and 84%/76% for surgery plus or minus chemotherapy and/or radiation. No CTCAE Grade 5 toxicities occurred. Only 8 patients (10%) experienced late Grade 3–4 toxicities. Sixteen patients (24%) developed late Grade 1–2 radiation-related toxicities, including proctitis, cystitis, dermatitis, and sacral insufficiency fractures.
Conclusion: Geriatric patients with cervical cancer tolerated multimodality treatment with acceptable toxicity and meaningful survival outcomes. These data support individualized, stage-appropriate treatment in older adults and highlight the need for further study of geriatric-specific treatment selection and quality-of-life outcomes.