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• W2758610594 abstract "Postoperative concurrent chemoradiotherapy (CRT) is an established treatment for early stage cervical cancer patients with a positive margin following hysterectomy. However, data regarding the benefit of a vaginal brachytherapy (VB) boost after external-beam radiotherapy (EBRT) are limited. Similarly, the impact of EBRT dose escalation is not well-defined. We sought to retrospectively examine the impact of VB boost and EBRT dose escalation on overall survival using the National Cancer Database (NCDB). The NCDB was queried from 2004-2012 for patients with FIGO stage I-IIB squamous cell carcinoma or adenocarcinoma of the cervix who had positive microscopic (R1) or macroscopic (R2) margins following simple or radical hysterectomy that went on to receive postoperative CRT by EBRT with or without a VB boost. Survival was assessed using Kaplan-Meier and log-rank regression analyses. Univariate and multivariate Cox and logistic regression analyses were used to compare demographic, clinical, and treatment characteristics that were related to survival and treatment. Small sample size and minimal differences between treatment groups negated the need for propensity-score matching and shared frailty analysis. We identified 438 patients that met inclusion criteria. Of patients undergoing an R1 resection, 198 (54.3%) received CRT with EBRT alone and 167 (45.8%) received EBRT + VB. Median overall survival (OS) was not significantly different between groups: 46.3 months for EBRT alone and 47.6 months for EBRT + VB (P = 0.91). For all patients receiving EBRT alone after R1 resection, overall survival was not significantly different for patients receiving greater than 5040 cGy than those receiving 5040 cGy or less (P = 0.13). For FIGO stage IIA patients with R1 or R2 resection (n = 54), median OS was significantly improved with the addition of VB boost to EBRT: 69.5 months versus 62.5 months (P = 0.02). When excluding R2 resection (n = 54), a trend for improved OS was observed with the addition of a VB boost to EBRT: 73.4 months versus 64.4 months (P = 0.06). On multivariate analysis, multi-agent versus single agent chemotherapy (HR 1.88, P = 0.03), node positivity (HR 1.74, P = 0.04), and pelvic lymph node dissection (HR 0.43, P = 0.02) were predictive of survival. On multivariate logistic regression analysis, only tumor size greater than 4 cm was predictive of receiving EBRT + VB versus EBRT alone (HR 2.21, P = 0.046). For early stage cervical cancer patients receiving postoperative chemoradiation, VB boost was associated with a survival benefit in patients with upper vaginal involvement and positive margins. When excluding patients with R2 resections, a trend towards improved survival persisted. In patients with R1 resections followed by EBRT alone with concurrent chemotherapy, there was no observable survival difference between patients receiving greater than 5040 cGy compared to those receiving 5040 cGy or less." @default.
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• W2758610594 date "2017-10-01" @default.
• W2758610594 modified "2023-09-27" @default.
• W2758610594 title "Vaginal Brachytherapy Boost in Margin Positive Early Stage Cervical Cancer" @default.
• W2758610594 doi "https://doi.org/10.1016/j.ijrobp.2017.06.557" @default.
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