Management of oligo-metastatic and oligo-recurrent cervical cancer: A pattern of care survey within the EMBRACE research network

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  • Supriya Chopra, Homi Bhabha National Institute
  • ,
  • Akshay Mangaj, Tata Memorial Hospital
  • ,
  • Alisha Sharma, Tata Memorial Hospital
  • ,
  • Li Tee Tan, Cambridge University Hospitals NHS Foundation Trust
  • ,
  • Alina Sturdza, Medical University of Vienna
  • ,
  • Ina Jürgenliemk-Schulz, Utrecht University
  • ,
  • Kathy Han, University of Toronto
  • ,
  • Fleur Huang, University of Alberta
  • ,
  • Maximilian P. Schmid, Medical University of Vienna
  • ,
  • Lars Fokdal
  • Cyrus Chargari, Institut Gustave Roussy
  • ,
  • Tamara Diendorfer, Medical University of Vienna
  • ,
  • Kari Tanderup
  • Richard Potter, Medical University of Vienna
  • ,
  • Remi A. Nout, Erasmus University Rotterdam

Background: In the metastatic or recurrent cervical cancer, systemic chemotherapy constitutes the main treatment. Though there is an increasing use of high dose external radiation and brachytherapy in the metastatic setting, no consensus exists. Methods: A 17-item survey was designed with additional case-based questions to explore present management of oligo-metastatic and oligo-recurrent cervix cancer within EMBRACE research group participating sites. The questions were designed to elicit prevailing practices in the management of de-novo oligo-metastasis and oligo-recurrent setting after completing the primary treatment of cervix cancer. The survey was sent electronically with two rounds of email reminders to respond over a 2-week survey period. The online survey was designed such that it was mandatory to complete all questions. The responses were recorded and results were summarized as proportions and summary statistics were generated. Results: Twenty-two centers responded to this survey. A majority (90%) of respondents reported a low incidence of de-novo oligo-metastatic cervical cancer in their practice (<5%), with a higher proportion of patients with oligo-recurrence after completing primary treatment (5–10%). All responding sites preferred to treat pelvic disease in the de-novo oligo-metastatic setting albeit with different fractionation regimens. While 68.2% of respondents recommended chemo-radiation and brachytherapy, 31.8% considered additional systemic therapy. Overall 77.3% centers recommended the use of stereotactic ablative radiation therapy to oligo-metastasis. For out-of-field nodal recurrences, 63.7% of respondents considered treating with curative intent, while 59% preferred treating in-field recurrence with palliative intent. A vast majority of the participating centers (90%) have stereotactic radiation therapy capacity and would consider a clinical trial addressing oligo-metastatic and oligo-recurrent cervical cancer. Conclusion: Although contemporary practice is variable, a substantial proportion of EMBRACE centers consider high dose radiation in de-novo metastatic and oligo-recurrence settings. However, there is clear need for a joint clinical protocol and prospective studies to address the role of high dose radiation within oligo-recurrent and oligo-metastatic scenarios.

OriginalsprogEngelsk
TidsskriftRadiotherapy and Oncology
Vol/bind155
Sider (fra-til)151-159
Antal sider9
ISSN0167-8140
DOI
StatusUdgivet - feb. 2021

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Publisher Copyright:
© 2020 Elsevier B.V.

Copyright:
Copyright 2020 Elsevier B.V., All rights reserved.

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