title: Addition of chemotherapy to definitive radiotherapy for IB1 and IIA1 cervical cancer: Analysis of the National Cancer Data Base.
abstract: OBJECTIVE
  The standard treatment for stage IB1 and IIA1 cervical carcinoma is surgery. For non-operative cases, the National Comprehensive Cancer Network recommends definitive radiotherapy (RT) with or without chemotherapy. This study sought to determine whether the addition of chemotherapy to RT improved overall survival (OS) for patients with stage IB1 and IIA1 cervical cancer.
  
  
  METHODS
  We used the National Cancer Data Base to identify patients with stage IB1 or stage IIA1 cervical cancer diagnosed in 2004 to 2012 who received definitive RT with or without chemotherapy. Patient, tumor, and treatment facility characteristics were assessed. Kaplan-Meier analysis was performed to compare overall survival (OS) between groups. Cox regression analysis was performed to identify factors associated with survival. Propensity-score matching was used to compare survival outcomes while accounting for indication bias.
  
  
  RESULTS
  825 patients met the specified criteria. 275 (33.3%) of patients received treatment with RT alone, whereas 550 (66.7%) were treated with CRT. The median OS in patients treated with RT alone was 121.1months, while the median OS for patients treated with CRT was not reached (hazard ratio [HR]=0.719; 95% confidence interval [CI] 0.549-0.945). Propensity-score matched analysis confirmed that CRT was superior to RT alone (HR=0.701; 95% CI 0.509 to 0.963).
  
  
  CONCLUSIONS
  Our study suggests the addition of chemotherapy to definitive RT in patients with stage IB1 or stage IIA1 cervical cancer is associated with an improvement in OS. Prospective studies are recommended to validate these results and to further investigate the quality of life differences associated with chemotherapy use.
authors: Department of Radiation Oncology, Greater Houston, Physicians in Medicine Association, The Woodlands, TX, United States.
authors: Waqar
authors: W
authors: Haque
authors: Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, NE, United States.
authors: Vivek
authors: V
authors: Verma
authors: Department of Radiation Oncology, University of Texas Health Science Center San Antonio, San Antonio, TX, United States.
authors: Mohamad
authors: M
authors: Fakhreddine
authors: Department of Radiation Oncology, University of Texas Medical Branch, Galveston, TX, United States.
authors: Sandra
authors: S
authors: Hatch
authors: Department of Radiation Oncology, Houston Methodist Hospital, Houston, TX, United States.
authors: E Brian
authors: EB
authors: Butler
authors: Department of Radiation Oncology, Houston Methodist Hospital, Houston, TX, United States. Electronic address: bteh@houstonmethodist.org.
authors: Bin S
authors: BS
authors: Teh
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D002277:Carcinoma / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy*; D017024:Chemotherapy, Adjuvant; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D057216:Propensity Score; D012189:Retrospective Studies; D015996:Survival Rate; D014481:United States; D002583:Uterine Cervical Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy*; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents
keywords: Cervical cancer; Cervix; Chemotherapy; Hysterectomy; Radiation therapy