Long-term survival following definitive radiation therapy for recurrence or oligometastases in gynecological malignancies: A landmark analysis

• Published in: Gynecologic oncology 2022-03, Vol.164 (3), p.550-557
• Main Authors: Corrigan, Kelsey L., Yoder, Alison, De, Brian, Lin, Lilie, Jhingran, Anuja, Joyner, Melissa M., Eifel, Patricia J., Colbert, Lauren E., Lu, Karen H., Klopp, Ann H.
• Format: Article
• Language: English
• Subjects: Carcinoma, Ovarian Epithelial; Disease-Free Survival; Endometrial Neoplasms - radiotherapy; Female; Gynecologic neoplasms; Humans; Lymphatic Metastasis; Neoplasm metastasis; Neoplasm Recurrence, Local - pathology; Neoplasm Recurrence, Local - radiotherapy; Ovarian Neoplasms; Radiotherapy; Retrospective Studies; Uterine Cervical Neoplasms - pathology; Vaginal Neoplasms - radiotherapy
• ISSN: 0090-8258; 1095-6859
• DOI: 10.1016/j.ygyno.2021.12.022

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. 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. 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%]). 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. •We studied recurrent or oligometastatic gynecological cancer (ROMGC) survivors following receipt of definitive RT.•48 patients were studied: 20 ovarian cancer, 16 endometrial cancer, 11 cervical cancer, 1 vaginal cancer.•Patients who received chemoradiation had better median DFS than those treated with RT alone (93 vs. 34 months, P = 0.05).•25 patients (52%) were alive and disease-free at median follow-up of 11.7 years.