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Research Letter
September 2018

Association of Definitive Pelvic Radiation Therapy With Survival Among Patients With Newly Diagnosed Metastatic Cervical Cancer

Author Affiliations
  • 1Department of Radiation Oncology, West Cancer Center, University of Tennessee Health Science Center, Memphis
  • 2Department of Hematology/Oncology, West Cancer Center, University of Tennessee Health Science Center, Memphis
  • 3Department of Gynecologic Oncology, West Cancer Center, University of Tennessee Health Science Center, Memphis
JAMA Oncol. 2018;4(9):1288-1291. doi:10.1001/jamaoncol.2018.2677

Definitive pelvic chemoradiation is the standard of care for locally advanced cervical cancer.1 However, the role of definitive local radiation therapy for metastatic cervical cancer has not been established. In addition, there is growing evidence that local therapies may be associated with an increase in survival among patients with some types of metastatic cancers.2-5 In this study, we evaluated overall survival among patients with metastatic cervical cancer treated with chemotherapy alone vs pelvic chemoradiation.

The National Cancer Database was used to identify patients with newly diagnosed metastatic cervical cancer who received chemotherapy with and without radiation therapy. Patients who received no treatment or treatment with radiation therapy alone, who underwent surgery, or who had missing baseline variables were excluded. Patients who received pelvic external beam radiationtherapy with or without brachytherapy were considered in the chemoradiation therapy group. Overall survival was analyzed using the Kaplan-Meier method, log-rank test, Cox proportional hazards models, landmark analysis, and propensity score–matched analyses using variables including radiation, age, year of diagnosis, race, comorbidity score, grade, clinical tumor stage and nodal stage, facility type, insurance, and metastatic site (distant lymph node, distant organ, or both). Overall survival was further analyzed by radiation dose (total dose, ≥45 Gy vs <45 Gy) and by radiation type (external beam radiation therapy plus brachytherapy vs external beam radiation therapy alone). Subgroup survival analyses were done by age, comorbidity score, clinical tumor stage and nodal stage, and metastatic site. All statistical analyses were done using SAS, version 9.4 (SAS Institute), with a 2-sided P ≤ .05 considered as statistically significant. Statistical analysis was performed in January 2018. Studies involving the National Cancer Database have been classified as not human subjects research by the University of Tennessee Health Science Center, and therefore this study was exempt from institutional review board review. All patients were deidentified in this study.