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Sequential or Concurrent Chemoradiation vs Radiation Alone After Hysterectomy for Cervical Cancer

January 28, 2021

Sequential chemoradiation resulted in higher disease-free survival (DFS) and lower risk of death compared with concurrent chemoradiation or radiation alone among patients with early-stage cervical cancer, according to a phase 3 trial published in JAMA Oncology (2021;e207168. doi:10.1001/jamaoncol.2020.7168).

“There is no current consensus on the role of chemotherapy in addition to radiation for postoperative adjuvant treatment of patients with early-stage cervical cancer with adverse pathological factors,” wrote He Huang, MD, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine (Guangzhou), and colleagues.

The phase 3 STARS trial aimed to compare sequential chemoradiation and concurrent chemoradiation compared with radiation alone as post-operative treatment for early-stage cervical cancer.

A total of 1048 patients who had received a radical hysterectomy for cervical cancer were included in the study and randomized in a 1:1:1 ratio to adjuvant radiation (n = 350), concurrent chemoradiation (n = 345), or sequential chemoradiation (n = 353). The primary end point was DFS at 3 years.

Baseline and disease characteristics were balanced among the treatment groups with the exception of lymph node involvement, which was lowest in the radiation group (18.3%).

In the intention-to-treat analysis, sequential chemoradiation showed higher rates of DFS than radiation and concurrent chemoradiation (90% vs 82% vs 85%, respectively). In addition, sequential chemoradiation was associated with decreased cancer death risk compared to radiation alone (92% vs 88%, respectively). Researchers saw no change by way of DFS and cancer death risk in patients treated with concurrent chemoradiation or radiation alone.

“In this randomized clinical trial, conducted in a postoperative adjuvant treatment setting, [sequential chemoradiation], rather than [concurrent chemoradiation], resulted in a higher DFS and lower risk of cancer death than [radiation therapy] among women with early-stage cervical cancer,” Dr Huang and colleagues concluded.—Marta Rybczynski

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