Addition of chemotherapy to radiation is associated with improved survival in older patients with cervical cancer: a Surveillance, Epidemiology, and End Results database analysis.

Abstract

Objective: We evaluated the effectiveness of chemoradiation compared with radiotherapy alone in older patients with cervical cancer and determined the age sub-group wherein chemotherapy loses its significance using the Surveillance, Epidemiology, and End Results database.

Methods: Women aged ≥65 years with cervical cancer who received definitive radiotherapy or chemoradiation were identified on the basis of the 2000-2019 Surveillance, Epidemiology, and End Results data. Overall and cancer-specific survival were compared in treatment groups, with survival prognostic factors assessed using multivariate analysis. Exploratory sub-group analyses at 5-year age increments determined the age threshold at which chemotherapy benefits became non-significant, with a multivariate p value ≥ .05 indicating reduced impact on overall and cancer-specific survival.

Results: A total of 1832 patients were included in the study. Of these, 563 patients received radiotherapy, and 1269 patients received chemoradiation. The median age of the cohort was 74 years (Q1-Q3, 69.00-80.00). The 5-year overall and cancer-specific survival rates were 40.52% and 53.47%, respectively. In the multivariate analysis, chemotherapy significantly improved both overall (HR 0.47, p < .001) and cancer-specific (HR 0.57, p < .001) survival. For cancer-specific survival, the chemotherapy benefits progressively decreased with age, remaining significant until the age of >75 years (HR 0.63, p < .001) and decreasing after the age of 80 years (HR 0.79, p = .12). However, for overall survival, the chemotherapy benefit was observed in all age groups, except for patients aged >85 years (HR 0.72, p = 0.14).

Conclusions: Chemotherapy was beneficial for women aged ≥65 years with cervical cancer who underwent radiotherapy. However, in patients aged >80 years, chemotherapy had no significant impact on cancer-specific survival.