title: Can chemotherapy boost the survival benefit of adjuvant radiotherapy in early stage cervical cancer with intermediate risk factors? A population based study.
abstract: OBJECTIVE
  The Gynecologic Oncology group (GOG) 0263 trial is currently exploring whether adding chemotherapy to adjuvant radiotherapy improves recurrence-free and/or overall survival in stage IB-IIA cervical cancer patients with pathologic intermediate-risk factors. Using the National Cancer Data Base, we evaluated the benefit of adjuvant chemoradiotherapy over adjuvant radiotherapy alone in the community practice setting.
  
  
  METHODS
  The analysis included 869 stage IB-IIA cervical cancer patients who underwent radical hysterectomy retrieving intermediate-risk factors justifying adjuvant therapy. Adjuvant chemoradiotherapy and adjuvant radiotherapy were delivered in 440 and 429 patients, respectively. Chi-square test assessed the distribution of variables in each group and the overall survival was estimated using the Kaplan-Meier method. Proportional hazard models were performed to evaluate the impact of the different prognostic factors on survival and propensity score analysis adjusted variables imbalanced distribution.
  
  
  RESULTS
  Adding chemotherapy to ART did not show a survival benefit at 48months median follow-up; the 5-year overall survival was 87% and 81% (p=0.6) in the adjuvant chemoradiotherapy and adjuvant radiotherapy groups, respectively. On univariate analysis, age older than 60, a higher comorbidity score, and stage IIA were significantly associated with worse survival, while none of the other covariates were significant prognosticator on multivariate analysis. The same findings held after propensity score analysis.
  
  
  CONCLUSIONS
  Our analysis could not detect a significant survival benefit for adjuvant chemoradiotherapy over adjuvant radiotherapy in women with intermediate-risk factors. Until GOG 0263 results become available, the benefits of adjuvant chemoradiotherapy should be considered on an individual basis within a multidisciplinary approach.
authors: Department of Radiation Oncology, Rutgers, the State University of New Jersey, Cancer Institute of New Jersey, New Brunswick, NJ, United States; Department of Radiation Oncology, Rutgers, the State University of New Jersey, New Jersey Medical School, Newark, NJ, United States. Electronic address: omar.mahmoud@rutgers.edu.
authors: Omar
authors: O
authors: Mahmoud
authors: Department of Radiation Oncology, Rutgers, the State University of New Jersey, Cancer Institute of New Jersey, New Brunswick, NJ, United States.
authors: Lara
authors: L
authors: Hathout
authors: Department of Radiation Oncology, Georgia Cancer Center, Augusta University, Augusta, GA, United States.
authors: Sherif G
authors: SG
authors: Shaaban
authors: Department of Radiation Oncology, Henry Ford Hospital, Detroit, MI, United States.
authors: Mohamed A
authors: MA
authors: Elshaikh
authors: Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, PA, United States.
authors: Sushil
authors: S
authors: Beriwal
authors: Department of Radiation Oncology, Loyola University, Chicago, IL, United States.
authors: William
authors: W
authors: Small
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000628:therapy*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000628:therapy*; D016022:Case-Control Studies; D059186:Chemoradiotherapy, Adjuvant / Q000379:methods*; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007044:Hysterectomy; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D057216:Propensity Score; D016016:Proportional Hazards Models; D018714:Radiotherapy, Adjuvant / Q000379:methods*; D012307:Risk Factors; D015996:Survival Rate; D047368:Tumor Burden; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000628:therapy*; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents
keywords: Adjuvant chemoradiotherapy; Adjuvant radiotherapy; Early stage cervical cancer; Intermediate risk factors