Long-Term Survival Following Definitive Radiation Therapy for Recurrence or Oligometastases in Gynecological Malignancies: A Landmark Analysis

Authors

Kelsey L Corrigan
Alison Yoder
Brian De
Lilie Lin
Anuja Jhingran
Melissa M Joyner
Patricia J Eifel
Lauren E Colbert
Karen H Lu
Ann H Klopp

Publication Date

3-1-2022

Journal

Gynecologic Oncology

Abstract

Objective: Radiation therapy (RT) may improve outcomes for patients with oligometastatic cancer. We sought to determine if there are long-term survivors treated with definitive RT for recurrent or oligometastatic gynecological cancer (ROMGC), and to evaluate the clinical and disease characteristics of these patients.

Methods: We performed a landmark analysis in 48 patients with ROMGC who survived for ≥5 years following definitive RT of their metastasis. Patient characteristics were extracted from the medical record. DFS was modeled using the Kaplan-Meier method.

Results: This cohort included 20 patients (42%) with ovarian cancer, 16 (33%) with endometrial cancer, 11 (23%) with cervical cancer, and one (2%) with vaginal cancer. The sites of ROMGC were the pelvic (46%), para-aortic (44%), supraclavicular (7%), mediastinal (4%), axillary (4%) lymph nodes and the lung (5.5%). Median total RT dose and fractionation were 62.1 Gy and 2.1 Gy/fraction; one patient was treated with SBRT. 32 patients (67%) received chemoradiation; these patients had higher rates of median DFS than those treated with RT alone (93 vs. 34 months, P = 0.05). At median follow-up of 11.7 years, 11 (23%) patients had progression of disease. 20 (42%) patients had died, 9 (19%) died from non-gynecologic cancer and 8 (17%) from gynecologic cancer (three were unknown). 25 (52%) patients were alive and disease-free (10 initially had endometrial cancer [63% of these patients], eight had cervical cancer [73%], six had ovarian cancer [30%], one had vaginal cancer [100%]).

Conclusions: Long-term survival is possible for patients treated with definitive RT for ROMG, however randomized data are needed to identify which patients derive the most benefit.

Keywords

Carcinoma, Ovarian Epithelial, Disease-Free Survival, Endometrial Neoplasms, Female, Humans, Lymphatic Metastasis, Neoplasm Recurrence, Local, Ovarian Neoplasms, Retrospective Studies, Uterine Cervical Neoplasms, Vaginal Neoplasms, Gynecologic neoplasms, Neoplasm metastasis, Radiotherapy

DOI

10.1016/j.ygyno.2021.12.022

PMID

34974906

PMCID

PMC9257896

PubMedCentral® Posted Date

3-1-2023

PubMedCentral® Full Text Version

Author MSS

Published Open-Access

yes