Oncologic outcomes according to the level of disease burden in patients with metachronous distant metastases from uterine cervical cancer: a Korean Radiation Oncology Group study (KROG 18-10)

Abstract

Objective This study aimed to evaluate the oncologic outcomes according to disease burden in uterine cervical cancer patients with metachronous distant metastases. Methods Between 2005 and 2015, 163 patients with metachronous distant metastases from uterine cervical cancer after receiving a definitive therapy were evaluated at seven institutions in Korea. Low metastatic burden was defined as less than 5 metastatic sites, whereas high metastatic burden was others. Each metastasis site was divided based on the lymph node (LN) and organs affected. The overall survival (OS) and progression-free survival (PFS) were assessed. Cox proportional hazards models, including other clinical variables, were used to evaluate the survival outcomes. Results The median follow-up duration was 22.2 months (range: 0.3–174.8 months). Para-aortic LNs (56.4%), lungs (26.4%), supraclavicular LNs (18.4%), and peritoneum (13.5%) were found to be the common metastasis sites. Among 37 patients with a single metastasis, 17 (45.9%) had LN metastases and 20 (54.1%) had organ metastases. The 1- and 2-year OS rates were 73.9% and 55.0%, respectively, whereas the PFS rates were 67.2% and 42.9%, respectively. SCC Ag after recurrence and high metastatic burden were significant factors affecting the OS (p=0.004 and p<0.001, respectively). Distant organ recurrence, short disease-free interval (≤2 years), and high metastatic burden were unfavorable factors for PFS (p=0.003, p=0.011, and p=0.002, respectively). Conclusion A favorable oncologic outcome can be expected by performing salvage treatments in selected patients with a long disease-free interval, low metastatic burden, and/or lymphatic-only metastasis.

A novel nomogram and risk stratification for early metastasis in cervical cancer after radical radiotherapy

“…However, it has limitations in preventing distant metastasis (DM) 5 . More than 20% of CC patients suffered from DM 5–7 and the 5‐year survival rate was only 17% 8,9 . Distant metastasis is now the main treatment failure pattern of CC 8,9 .…”

“… 5 More than 20% of CC patients suffered from DM 5 , 6 , 7 and the 5‐year survival rate was only 17%. 8 , 9 Distant metastasis is now the main treatment failure pattern of CC. 8 , 9 Even with the application of small molecular agents like bevacizumab or immunotherapy such as pembrolizumab, the survival outcomes are not satisfying while creating financial burdens simultaneously.…”

“… 8 , 9 Distant metastasis is now the main treatment failure pattern of CC. 8 , 9 Even with the application of small molecular agents like bevacizumab or immunotherapy such as pembrolizumab, the survival outcomes are not satisfying while creating financial burdens simultaneously. 6 , 10 Therefore, it is urgent to predict the susceptibilities of DM in CC patients to make personalized treatment plans and alleviate such dilemmas.…”