Salvage Treatment and Outcomes of Locally Advanced Cervical Cancer after Failed Concurrent Chemoradiation with or without Adjuvant Chemotherapy: Post Hoc Data Analysis from the ACTLACC Trial

Abstract

Objectives: To evaluate the type of salvage treatment and outcomes of patients with locally advanced cervical cancer who failed treatment with concurrent chemoradiation with or without adjuvant chemotherapy. Methods: This was post hoc analyses of data from the randomized trial which included 259 patients who had FIGO stage IIB-IVA and had either pelvic radiation therapy concurrent with cisplatin followed by observation or paclitaxel plus carboplatin. Data of the patients who failed primary treatment were collected: type of salvage treatments, time to progress after salvage therapy, progression-free (PFS) and overall survivals (OS). Results: After primary treatment, 85 patients had either persistence (36.5%), progression (18.8%), or recurrences (44.7%). The sites of failure were loco/regional in 52.9%, systemic failure in 30.6%, and loco-regional and systemic in 16.5%. Chemotherapy was given in 51.8%, being the sole therapy in 34.1%. Majority were combination agents (31.8%), with paclitaxel/carboplatin as the most common regimen. Radiation to the metastatic sites along with chemotherapy was used in 14.1% whereas palliative radiation therapy or supportive care was used in approximately 10% of each. The median time from the start of salvage treatment to progression was 9.2 months (range 0.2-64.0 months) with median PFS of 11.2 months (95% CI, 7.2-15.3 months). Median overall survival 27.3 months (95% CI, 4.4-69.6 months). Conclusions: Chemotherapy, either alone or with radiation therapy, was the most common salvage treatment in LACC after failure from primary treatment. The time to progress and PFS were less than 1 year with OS of approximately 2 years.

Clinical analysis of decision implementation by a multidisciplinary team in cervical cancer cases in Ganzhou, China

“…Postoperative staging can guide the way of postoperative adjuvant therapy such as radiotherapy, chemotherapy, or concurrent radiotherapy ( 28 ). Patients with advanced tumors can have PD-L1 mutation, the detection of which can guide different treatments of cervical cancer such as targeted treatment or immunization to determine the survival prognosis of patients and other conditions ( 29 – 35 ). If pregnant patients with cervical cancer choose to terminate their pregnancy, then the appropriate time to terminate the pregnancy and a reasonable and individualized treatment plan should be selected.…”

Receptor-interacting protein kinase 1 (RIPK1) regulates cervical cancer cells via NF-κB–TNF-α pathway: An in vitro study

“…Surgery is indicated in the early stages, and although radiotherapy and chemotherapy are used in clinical practice, the response rate is limited in patients with advanced cervical cancer or those who develop metastasis. Therefore, further research on improved treatment approaches is necessary [5] , [6] , [7] , [8] . The combination of targeted therapy and other therapies has emerged as a new model to treat advanced cervical cancer.…”

A Retrospective Study of Chemotherapy and 3D-Image-Guided Afterloading Intracavitary Radiotherapy in Locally Advanced Cervical Cancer

“…Also, they can reduce the difficulty of surgery, improve the surgical resection rate of patients, and control tumors effectively [13]. Research has proven that combining radiotherapy with chemotherapy is an even more effective way to improve the local control rate of advanced CC [14]. However, radiotherapy alone can increase drug resistance and lead to many side effects.…”