title: Is age a prognostic biomarker for survival among women with locally advanced cervical cancer treated with chemoradiation? An NRG Oncology/Gynecologic Oncology Group ancillary data analysis.
abstract: OBJECTIVE
  To determine the effect of age on completion of and toxicities following treatment of local regionally advanced cervical cancer (LACC) on Gynecologic Oncology Group (GOG) Phase I-III trials.
  
  
  METHODS
  An ancillary data analysis of GOG protocols 113, 120, 165, 219 data was performed. Wilcoxon, Pearson, and Kruskal-Wallis tests were used for univariate and multivariate analysis. Log rank tests were used to compare survival lengths.
  
  
  RESULTS
  One-thousand-three-hundred-nineteen women were included; 60.7% were Caucasian, 15% were age 60-70years and an additional 5% were >70; 87% had squamous histology, 55% had stage IIB disease and 34% had IIIB disease. Performance status declined with age (p=0.006). Histology and tumor stage did not significantly differ. Number of cycles of chemotherapy received, radiation treatment time, nor dose modifications varied with age. Notably, radiation protocol deviations and failure to complete brachytherapy (BT) did increase with age (p=0.022 and p<0.001 respectively). Only all grade lymphatic (p=0.006) and grade≥3 cardiovascular toxicities (p=0.019) were found to vary with age. A 2% increase in the risk of death for every year increase >50 for all-cause mortality (HR 1.02; 95% CI, 1.01-1.04) was found, but no association between age and disease specific mortality was found.
  
  
  CONCLUSIONS
  This represents a large analysis of patients treated for LACC with chemo/radiation, approximately 20% of whom were >60years of age. Older patients, had higher rates of incomplete brachytherapy which is not explained by collected toxicity data. Age did not adversely impact completion of chemotherapy and radiation or toxicities.
authors.affiliation: Division of Gynecologic Oncology, Stephenson Oklahoma Cancer Center at the University of Oklahoma, 800 NE 10th Street, Oklahoma City, OK 73121, United States. Electronic address: kathleen-moore@ouhsc.edu.
authors.forename: Kathleen N
authors.initials: KN
authors.lastname: Moore
authors.affiliation: NRG Oncology Statistics & Data Management Center, Roswell Park Cancer Institute, Buffalo, NY 14263, United States. Electronic address: james.j.java@gmail.com.
authors.forename: James J
authors.initials: JJ
authors.lastname: Java
authors.affiliation: Division of Gynecologic Oncology, Ochsner Medical Center, 1514 Jefferson Hwy, New Orleans, LA 70121, United States. Electronic address: katrina-slaughter@ouhsc.edu.
authors.forename: Katrina N
authors.initials: KN
authors.lastname: Slaughter
authors.affiliation: Division of Gynecologic Oncology, Cleveland Clinic Foundation, Cleveland, OH 44109, United States. Electronic address: rosep@ccf.org.
authors.forename: Peter G
authors.initials: PG
authors.lastname: Rose
authors.affiliation: Dept. of Radiation Oncology, Crozer Keystone Regional Cancer Center at Broomall, Crozer Keystone Health System, Broomall, PA 19008, United States. Electronic address: rlancmd@gmail.com.
authors.forename: Rachelle
authors.initials: R
authors.lastname: Lanciano
authors.affiliation: Division of Gynecologic Oncology, Women & Infants Hospital, Providence, RI 02905, United States. Electronic address: pdisilvestro@wihri.org.
authors.forename: Paul A
authors.initials: PA
authors.lastname: DiSilvestro
authors.affiliation: Division of Medical Oncology, University of Mississippi Medical Center, Jackson, MS 39216, United States. Electronic address: jtthigpen@att.net.
authors.forename: J Tate
authors.initials: JT
authors.lastname: Thigpen
authors.affiliation: Division of Gynecologic Oncology, State University of New York Downstate, Brooklyn, NY 11203, United States. Electronic address: yi-chun.lee@downstate.edu.
authors.forename: Yi-Chun
authors.initials: YC
authors.lastname: Lee
authors.affiliation: Division of Gynecologic Oncology, University of California at Irvine, Orange, CA 92868, United States. Electronic address: ktewari@uci.edu.
authors.forename: Krishnansu S
authors.initials: KS
authors.lastname: Tewari
authors.affiliation: Radiation Oncology, Duke University Medical Center, Durham, NC 27710, United States. Electronic address: junzo.chino@duke.edu.
authors.forename: Junzo
authors.initials: J
authors.lastname: Chino
authors.affiliation: Division of Gynecologic Oncology, Wayne State University/Karmanos Cancer Center, Detroit, MI 48201, United States. Electronic address: sseward@med.wayne.edu.
authors.forename: Shelly M
authors.initials: SM
authors.lastname: Seward
authors.affiliation: Division of Gynecologic Oncology, UT Southwestern Medical Center at Dallas, Dallas, TX 75390, United States. Electronic address: David.Miller@utsouthwestern.edu.
authors.forename: David S
authors.initials: DS
authors.lastname: Miller
authors.affiliation: Division of Gynecologic Oncology, Ohio State University Medical Center, Columbus, OH 43210, United States. Electronic address: ritu.salani@osumc.edu.
authors.forename: Ritu
authors.initials: R
authors.lastname: Salani
authors.affiliation: Division of Obstetrics & Gynecology, Franciscan St. Francis Health, Indianapolis, IN 46237, United States. Electronic address: David.Moore@franciscanalliance.org.
authors.forename: David H
authors.initials: DH
authors.lastname: Moore
authors.affiliation: Division of Gynecologic Oncology, Indiana University School of Medicine, Mel and Bren Simon Cancer Center, Indianapolis, IN 46202, United States. Electronic address: fstehman@iupui.edu.
authors.forename: Frederick B
authors.initials: FB
authors.lastname: Stehman
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers; D001918:Brachytherapy; D059248:Chemoradiotherapy; D005260:Female; D006801:Humans; D008875:Middle Aged; D011379:Prognosis; D002583:Uterine Cervical Neoplasms / Q000401:mortality / Q000628:therapy*
chemical_list: D015415:Biomarkers
keywords: Biomarkers; Cervical cancer; Chemoradiation