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    Postoperative chemoradiotherapy versus radiotherapy alone for elderly cervical cancer patients with positive margins, lymph nodes, or parametrial invasion

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    Author
    Cushman, Taylor R
    Haque, Waqar
    Menon, Hari
    Rusthoven, Chad G
    Butler, E Brian
    Teh, Bin S
    Verma, Vivek
    Affiliation
    Univ Arizona, Coll Med Phoenix
    Issue Date
    2018-11-01
    Keywords
    Cervical Cancer
    Chemotherapy
    Elderly
    Geriatrics
    Radiation Therapy
    
    Metadata
    Show full item record
    Publisher
    KOREAN SOC GYNECOLOGY ONCOLOGY & COLPOSCOPY
    Citation
    Cushman TR, Haque W, Menon H, Rusthoven CG, Butler EB, Teh BS, Verma V. Postoperative chemoradiotherapy versus radiotherapy alone for elderly cervical cancer patients with positive margins, lymph nodes, or parametrial invasion. J Gynecol Oncol. 2018 Nov;29(6):e97. https://doi.org/10.3802/jgo.2018.29.e97
    Journal
    JOURNAL OF GYNECOLOGIC ONCOLOGY
    Rights
    © 2018. Asian Society of Gynecologic Oncology, Korean Society of Gynecologic Oncology.
    Collection Information
    This item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at repository@u.library.arizona.edu.
    Abstract
    Women with cervical cancer (CC) found to have positive surgical margins, positive lymph nodes, and/or parametrial invasion receive a survival benefit from postoperative chemoradiotherapy (CRT) vs. radiation therapy (RT) alone. However, older women may not benefit to the same extent, as they are at increased risk of death from non-oncologic causes as well as toxicities from oncologic treatments. This study sought to evaluate whether there was a survival benefit of CRT over RT in elderly patients with cervical cancer. Methods: The National Cancer Database was queried for patients >= 70 years old with newly diagnosed IA2, IB, or IIA CC and positive margins, parametrial invasion, and/or positive nodes on surgical resection. Statistics included logistic regression, Kaplan-Meier overall survival (OS), and Cox proportional hazards modeling analyses. Results: Altogether, 166 patients met inclusion criteria; 62 (37%) underwent postoperative RT and 104 (63%) underwent postoperative CRT. Younger patients and those living in areas of higher income were less likely to receive CRT, while parametrial invasion and nodal involvement were associated with an increased likelihood (p<0.05 for all). There were no OS differences by treatment type. Subgroup analysis by number of risk factors, as well as each of the 3 risk factors separately, also did not reveal any OS differences between cohorts. Conclusion: In the largest such study to date, older women with postoperative risk factor(s) receiving RT alone experienced similar survival as those undergoing CRT. Although causation is not implied, careful patient selection is paramount to balance treatment-related toxicity risks with theoretical outcome benefits.
    Note
    Open access journal.
    ISSN
    2005-0399
    PubMed ID
    30207105
    DOI
    10.3802/jgo.2018.29.e97
    Version
    Final published version
    Additional Links
    https://synapse.koreamed.org/DOIx.php?id=10.3802/jgo.2018.29.e97
    ae974a485f413a2113503eed53cd6c53
    10.3802/jgo.2018.29.e97
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