Chemoradiation Benefits for Cervical Cancer May Decline After Age 80

Among patients with cervical cancer who underwent radiotherapy, chemotherapy proved to be beneficial; however, chemotherapy had no significant impact on cancer-specific survival in patients with cervical cancer aged 80 years or older, according to study findings published by Elsevier.

After a median follow-up of 22 months, the five-year overall and cancer-specific survival rates were 40.52% in the radiotherapy alone group and 53.47% in the chemoradiation group. Multivariate analysis showed chemotherapy significantly improved both overall (53% reduction in risk) and cancer-specific (43% reduction in risk) survival. For cancer-specific survival, chemotherapy benefits decreased with age, remaining significant until age 75 years or greater (37% reduction in risk) and lessening after age 80 years (21% reduction in risk). Chemotherapy benefits were seen in all age groups for overall survival, except for those aged greater than 85 years (28% reduction in risk).

The standard treatment for locally advanced cervical cancer is concurrent chemoradiation, as per the study. However, it remains unclear whether concurrent chemoradiation provides a significant advantage over radiotherapy alone in terms of oncological outcomes for older patients (aged 65 years and older), particularly in the oldest age groups.

“Our findings indicate that adding chemotherapy to radiotherapy, particularly concurrent chemoradiation, provides therapeutic benefits for women aged 65 years, which appeared to decrease after the age of 80 years,” first study author, Dr. Kittinun Leetanporn, Prince of Songkla University, Department of Biomedical Sciences and Biomedical Engineering, and colleagues wrote. “This suggests increased usefulness of concurrent chemoradiation in patients aged 65 to 80 years.”

Study authors recommend prescribing chemoradiation as the standard of care for woman aged 65 to 80 years with cervical cancer.

A total of 4,611 patients were evaluated, of which 692 (15%) had distant metastasis, 525 (11.4%) had unknown TNM status, 739 (16%) had two primary tumors and 823 (17.8%) had incomplete data and were excluded, resulting in a final sample of 1,832 patients. Out of the 1,832 patients included on the study (median age of 74 years), 563 received radiotherapy and 1,269 underwent chemoradiation.

Women aged 65 years or older with cervical cancer who received definitive radiotherapy or chemoradiation were identified using the 2000-2019 Surveillance, Epidemiology and End Results (SEER) data; however, as mentioned by study authors, the database lacked critical details, which included radiotherapy dosage, treatment fields, chemotherapy agents or regimens, number of chemotherapy cycles and the specific use of combined therapies (such as concurrent or sequential chemoradiation). As such, study authors recommend using caution when interpreting the study data.

“Tailoring treatment strategies for older patients with cancer is crucial to achieve optimal outcomes while minimizing complications, particularly considering current precision medicine trends,” Leetanporn wrote.

Overall survival and cancer-specific survival were assessed and compared across treatment groups. Exploratory subgroup analyses, conducted in five-year age increments, determined the age threshold at which the benefits of chemotherapy were no longer significant.

“Therefore, treatment decisions for older patients should carefully balance the potential benefits and risks of chemotherapy, particularly in those aged 80 years [or older],” Leetanporn concluded.

Reference:

“Addition of chemotherapy to radiation is associated with improved survival in older patients with cervical cancer: a Surveillance, Epidemiology, and End Results database Analysis,” by Dr. Kittinun Leetanaporn, et al. Elsevier.

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