Management of oligo-metastatic and oligo-recurrent cervical cancer: A pattern of care survey within the EMBRACE research network

Chopra, Supriya; Mangaj, Akshay; Sharma, Alisha; Tan, Li Tee; Sturdza, Alina; Jürgenliemk-Schulz, Ina M.; Han, Kathy; Huang, Fleur; Schmid, Maximilian; Fokdal, Lars; Chargari, Cyrus; Diendorfer, Tamara; Tanderup, Kari; Pötter, Richard; Nout, Remi A.

doi:10.1016/j.radonc.2020.10.037

Cited by 16 publications

(12 citation statements)

References 37 publications

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“…Moreover, previous chemotherapy lines and, above all, adoption of bevacizumab has to be taken into account given the increased rates of fistulae formation after bevacizumab therapy (5–9%) 29–31. As a logical result, efforts targeted at designing prospective trials for a better definition of stereotactic body radiotherapy regimens could be beneficial in order to align the approaches, and produce more consistent and reliable results 25 32 33…”

Section: Discussionmentioning

confidence: 99%

Stereotactic body radiotherapy in oligometastatic cervical cancer (MITO-RT2/RAD study): a collaboration of MITO, AIRO GYN, and MaNGO groups

Macchia

Nardangeli

Laliscia

et al. 2022

Int J Gynecol Cancer

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ObjectiveThis retrospective, multicenter study analyzes the efficacy and safety of stereotactic body radiotherapy in a large cohort of patients with oligometastatic/persistent/recurrent cervical cancer.MethodsA standardized data collection from several radiotherapy centers that treated patients by stereotactic body radiotherapy between March 2006 and February 2021 was set up. Clinical and stereotactic body radiotherapy parameters were collected. Objective response rate was defined as a composite of complete and partial response, while clinical benefit included objective response rate plus stable disease. Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer and Common Terminology Criteria for Adverse Events scales were used to grade toxicities. The primary endpoints were the rate of complete response to stereotactic body radiotherapy, and the 2 year actuarial local control rate on a ‘per lesion’ basis. The secondary end points were progression-free survival and overall survival, as well as toxicity.ResultsA total of 83 patients with oligometastatic/persistent/recurrent cervical cancer bearing 125 lesions treated by stereotactic body radiotherapy at 15 different centers were selected for analysis. Of the sites of metastatic disease, lymph node metastases were most common (55.2%), followed by parenchyma lesions (44.8%). Median total dose was 35 Gy (range 10–60), in five fractions (range 1–10), with a median dose/fraction of 7 Gy (range 4–26). Complete, partial, and stable response were found in 73 (58.4%), 29 (23.2%), and 16 (12.8%) lesions, respectively, reaching 94.4% of the clinical benefit rate. Forty-six (55.4%) patients had a complete response. Patients achieving complete response on a ‘per lesion’ basis experienced a 2 year actuarial local control rate of 89.0% versus 22.1% in lesions not achieving complete response (p<0.001). The 2 year actuarial progression-free survival rate was 42.5% in patients with complete response versus 7.8% in patients with partial response or stable or progressive disease (p=0.001). The 2 year actuarial overall survival rate was 68.9% in patients with complete response versus 44.3% in patients with partial response or stable or progressive disease (p=0.015). Fifteen patients (18.1%) had mild acute toxicity, totaling 29 side events. Late toxicity was documented in four patients (4.8%) totaling seven adverse events.ConclusionOur analysis confirmed the efficacy of stereotactic body radiotherapy in oligometastatic/persistent/recurrent cervical cancer patients. The low toxicity profile encourages the wider use of stereotactic body radiotherapy in this setting.

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Section: Discussionmentioning

confidence: 99%

Stereotactic body radiotherapy in oligometastatic cervical cancer (MITO-RT2/RAD study): a collaboration of MITO, AIRO GYN, and MaNGO groups

Macchia

Nardangeli

Laliscia

et al. 2022

Int J Gynecol Cancer

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“…Local RT also helps to alleviate the symptoms and pain associated with the disease. In a survey conducted within the EMBRACE group, it was revealed that all the participants agreed on delivering local RT in OMD with 68.2 per cent preferring CCRT and BT while 31.8 per cent preferred adding systemic therapy 34 . There is evidence that local RT improves survival in metastatic cervical cancer at presentation as shown in above studies; though most of the data are retrospective and prospective studies are needed.…”

Section: Role Of Pelvic Radiation In Patients With De Novo ...mentioning

confidence: 99%

“…Although the evidence in pelvic re-irradiation using hypofractionated SBRT in cervical cancer is emerging, data from other pelvic malignancies have shown promising results 135 . A survey within the EMBRACE network showed that for out-of-RT field nodal recurrences, 63.7 per cent preferred treating with the intent of curing the disease with RT and CTh, while for in RT field recurrences, palliation was the aim of the treatment 34 . Thus, re-irradiation of the pelvis in recurrent cervical cancer is an area of significant uncertainty and further trials are warranted.…”

Section: Locoregional Recurrence After Curative Therapymentioning

confidence: 99%

“…A nomogram is also available to stratify oligometastatic patients based on the sex of the patient, timing of presentation of the disease, presence of intracranial metastases, histology and KPS score and to plan individualized care 136 . A recent survey highlighted the need of joint approach and clinical trials to decide the optimal management of OMD and ORD in cervical cancer 34 .…”

Section: Future Considerationsmentioning

confidence: 99%

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Defining the role of high-dose radiation in oligometastatic & oligorecurrent cervical cancer

Mangaj,

Chopra,

Nout

2021

Indian Journal of Medical Research

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Around 5-8 per cent of women diagnosed with cervical cancer present with metastatic disease at presentation and 16-25 per cent of patients fail at either within irradiated fields or at distant sites post-curative therapy in advanced cervical cancers. Conventionally, chemotherapy with palliative intent constituted the mainstay of treatment with modest survival outcomes and radiation therapy was reserved for symptomatic benefit only. While targeted therapies and immunotherapy have been added in therapeutic armamentarium, the impact on the outcomes is modest. In limited metastatic disease, radiation therapy to metastatic sites from different primary cancers has shown survival benefits; however, the data are scarce in cervical cancer. With a better understanding of the molecular biology of the metastases and recurrence pattern, emphasis is laid upon total eradication of the disease rather than offering relief from symptoms. This article summarizes the role of radiation therapy in limited metastatic disease and recurrent cervical cancer.

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“…For International Federation of Gynecology and Obstetrics (FIGO) stage IA1 to IB1, surgery is the main treatment with adjuvant radiotherapy (RT) ± chemotherapy in case of risk factors, and for the FIGO stage IB2–IVA, concurrent chemoradiotherapy (CCRT) represents the standard [ 2 ]. Definitive RT ± chemotherapy can also be used for patients with the FIGO stage IVB with oligometastasis [ 3 ] or who are not candidates for hysterectomy. Neoadjuvant chemotherapy remains controversial for locally advanced cervical cancer [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

Machine Learning of Dose-Volume Histogram Parameters Predicting Overall Survival in Patients with Cervical Cancer Treated with Definitive Radiotherapy

Yang

Liu

et al. 2022

Journal of Oncology

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Purpose. To analyze the effects of dosimetric parameters and clinical characteristics on overall survival (OS) by machine learning algorithms. Methods and Materials. 128 patients with cervical cancer were treated with definitive pelvic radiotherapy with or without chemotherapy followed by image-guided brachytherapy. The elastic-net models with integrating DVH parameters and baseline clinical factors, only DVH parameters and only baseline clinical factors were constructed in 5-folds cross-validations for 100 iteration bootstrapping, and then were compared using concordance index (C-index) criteria. Finally, the selected important factors were used to build multivariable Cox-pH models for OS and also shown in nomograms for clinical usage. Results. The median OS occurred was 25.78 months with 25 (19.53%) deaths. The elastic-net models integrating clinical and DVH factors had the best prediction performances (C-index 0.76 in the train set and C-index 0.74 in the test set). Three important factors were selected, including baseline hemoglobin level as the protective factor, primary tumor volume (GTV_P) volume, and body V5 as the risk factors. The final multivariable Cox-pH models were constructed using these important factors and had prediction performance (C-index: 0.78, 95%CI: 0.73–0.81). Conclusions. This is the first attempt to establish elastic-net models to study the contributions of DVH parameters for predicting OS in patients with cervical cancer. These results can facilitate individualized tailoring of radiation treatment in cervical cancer patients.

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Management of oligo-metastatic and oligo-recurrent cervical cancer: A pattern of care survey within the EMBRACE research network

Cited by 16 publications

References 37 publications

Stereotactic body radiotherapy in oligometastatic cervical cancer (MITO-RT2/RAD study): a collaboration of MITO, AIRO GYN, and MaNGO groups

Stereotactic body radiotherapy in oligometastatic cervical cancer (MITO-RT2/RAD study): a collaboration of MITO, AIRO GYN, and MaNGO groups

Defining the role of high-dose radiation in oligometastatic & oligorecurrent cervical cancer

Machine Learning of Dose-Volume Histogram Parameters Predicting Overall Survival in Patients with Cervical Cancer Treated with Definitive Radiotherapy

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