Background Cervical cancer (CC) ranks the fourth most common malignancies and its burden is increasingly affecting younger women. However, the correlation between age and CC prognosis is still uncertain. This retrospective study aims to analyze the efficacy and safety of definitive volumetric modulated arc therapy (VMAT) combined with adaptive brachytherapy (BT) with or without concurrent chemotherapy in CC patients of different age groups. Methods Totally 541 CC patients diagnosed from 2014 to 2019 in our institution were enrolled and classified into 3 groups: the youth (18–44 years old), the middle-aged (45–59 years old) and the elderly (<InlineEquation ID="IEq1"> <EquationSource Format="TEX">\(\ge 60\)</EquationSource> </InlineEquation> years old). Clinical outcomes including locoregional control (LC), progression-free survival (PFS), overall survival (OS) and distant metastasis-free survival (DMFS) were analyzed. Toxicities graded by the Common Terminology Criteria for Adverse Events (CTCAE, version 5.0) including hematologic, gastrointestinal and urinary toxicities were analyzed. Comparison among three groups was conducted by <InlineEquation ID="IEq2"> <EquationSource Format="TEX">\(\chi ^{2}\)</EquationSource> </InlineEquation> test and Fisher’s exact test before and after 1:1:1 ratio propensity score matching (PSM). Results The median follow-up time was 65 months. Of 541 CC patients, the age-standardized 5-year rates for OS, PFS, LC and DMFS were 83.2%, 76.5%, 87.6% and 85.0% respectively. Before PSM, there was significant difference among three groups in OS (P = 0.035), but not in PFS, LC and DMFS. The 5-year OS for the youth, middle-aged and elderly group were 76.9%, 87.1% and 89.8% respectively. After PSM, there were 38 patients matched respectively in three groups, but there were no significant differences in OS, PFS, LC and DMFS. For acute toxicities, the incidences of grade 3 or 4 acute anemia of the youth, middle-aged and elderly groups after PSM were 34.2%, 13.2% and 15.8% respectively(P = 0.012). For late toxicities, the incidences of grade 3 or 4 cystitis and enterocolitis were 0.0% and 1.1%, and there was no significant difference among three groups. Conclusion Definitive VMAT combined with 3D-IGBT with or without concurrent chemotherapy for CC treatment was effective and safe for patients of all age groups. But age is not an independent risk factor for CC prognosis.

Comparison of efficacy and safety of definitive chemoradiotherapy for cervical cancer patients of different age groups using propensity score matching

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2026年1月13日

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Xueyi Su,
Haiying Wu,
Xiangtong Chen,
Yi Ouyang,
Junyun Li,
Kai Chen,
Xiaodan Huang,
Foping Chen,
Xinping Cao

摘要

Background

Cervical cancer (CC) ranks the fourth most common malignancies and its burden is increasingly affecting younger women. However, the correlation between age and CC prognosis is still uncertain. This retrospective study aims to analyze the efficacy and safety of definitive volumetric modulated arc therapy (VMAT) combined with adaptive brachytherapy (BT) with or without concurrent chemotherapy in CC patients of different age groups.

Methods

Totally 541 CC patients diagnosed from 2014 to 2019 in our institution were enrolled and classified into 3 groups: the youth (18–44 years old), the middle-aged (45–59 years old) and the elderly ( \(\ge 60\) years old). Clinical outcomes including locoregional control (LC), progression-free survival (PFS), overall survival (OS) and distant metastasis-free survival (DMFS) were analyzed. Toxicities graded by the Common Terminology Criteria for Adverse Events (CTCAE, version 5.0) including hematologic, gastrointestinal and urinary toxicities were analyzed. Comparison among three groups was conducted by \(\chi ^{2}\) test and Fisher’s exact test before and after 1:1:1 ratio propensity score matching (PSM).

Results

The median follow-up time was 65 months. Of 541 CC patients, the age-standardized 5-year rates for OS, PFS, LC and DMFS were 83.2%, 76.5%, 87.6% and 85.0% respectively. Before PSM, there was significant difference among three groups in OS (P = 0.035), but not in PFS, LC and DMFS. The 5-year OS for the youth, middle-aged and elderly group were 76.9%, 87.1% and 89.8% respectively. After PSM, there were 38 patients matched respectively in three groups, but there were no significant differences in OS, PFS, LC and DMFS. For acute toxicities, the incidences of grade 3 or 4 acute anemia of the youth, middle-aged and elderly groups after PSM were 34.2%, 13.2% and 15.8% respectively(P = 0.012). For late toxicities, the incidences of grade 3 or 4 cystitis and enterocolitis were 0.0% and 1.1%, and there was no significant difference among three groups.

Conclusion

Definitive VMAT combined with 3D-IGBT with or without concurrent chemotherapy for CC treatment was effective and safe for patients of all age groups. But age is not an independent risk factor for CC prognosis.