Top Line: Does adding concurrent cisplatin to post-op radiation improve outcomes for intermediate-risk cervical cancer after hysterectomy?
The Study: Adjuvant therapy for early stage cervical cancer treated with primary hysterectomy is guided by the presence of risk factors. The Sedlis criteria are a widely used set of risk factors that define intermediate risk disease in the absence of any high risk features. They include: tumor size ≥4cm, deep cervical stroma invasion (DSI), and lymphovascular space invasion (LVI). To be intermediate risk, these risk factors need to combine in the following ways: LVI plus outer third DSI regardless of size, middle third DSI plus size ≥2cm regardless of LVI, or size ≥5cm regardless of DSI or LVI. In NRG/GOG-0263, 316 women with stage I-IIA, intermediate risk cervical cancer were randomized to receive standard adjuvant pelvic radiation with or without weekly cisplatin. At 3 years, the rate of RFS was not significantly improved with the addition of cisplatin (88.5% v 85.4%), although there was a strong trend (HR 0.698, p=0.09). The same held true for overall survival at 97.2% v 90.3% (HR 0.586, p=0.07). Grade 3+ toxicity was significantly higher with the addition of cisplatin (43% v 15%), and quality of life also took a temporary hit before rebounding at 9 months. An interesting finding in subgroup analyses was a potential interaction between radiation modality and cisplatin benefit. Those treated with IMRT didn’t derive benefit from cisplatin while those treated with 3D conformal did. A recent NCDB analysishttps://quadshotnews.com/sedlis-debate/ also found no difference in survival outcomes with cisplatin for intermediate risk disease.
TBL: In GOG-0263, the addition of cisplatin to adjuvant radiation numerically increased RFS and OS at 3 years, though those outcomes did not reach statistical significant, and cisplatin also nearly tripled grade 3+ toxicity. So while cisplatin may not become a standard go-to in this population, the numeric improvements may merit consideration for those at the higher end of the intermediate risk spectrum. | Ryu, Ann Oncol 2025
The Study: Adjuvant therapy for early stage cervical cancer treated with primary hysterectomy is guided by the presence of risk factors. The Sedlis criteria are a widely used set of risk factors that define intermediate risk disease in the absence of any high risk features. They include: tumor size ≥4cm, deep cervical stroma invasion (DSI), and lymphovascular space invasion (LVI). To be intermediate risk, these risk factors need to combine in the following ways: LVI plus outer third DSI regardless of size, middle third DSI plus size ≥2cm regardless of LVI, or size ≥5cm regardless of DSI or LVI. In NRG/GOG-0263, 316 women with stage I-IIA, intermediate risk cervical cancer were randomized to receive standard adjuvant pelvic radiation with or without weekly cisplatin. At 3 years, the rate of RFS was not significantly improved with the addition of cisplatin (88.5% v 85.4%), although there was a strong trend (HR 0.698, p=0.09). The same held true for overall survival at 97.2% v 90.3% (HR 0.586, p=0.07). Grade 3+ toxicity was significantly higher with the addition of cisplatin (43% v 15%), and quality of life also took a temporary hit before rebounding at 9 months. An interesting finding in subgroup analyses was a potential interaction between radiation modality and cisplatin benefit. Those treated with IMRT didn’t derive benefit from cisplatin while those treated with 3D conformal did. A recent NCDB analysishttps://quadshotnews.com/sedlis-debate/ also found no difference in survival outcomes with cisplatin for intermediate risk disease.
TBL: In GOG-0263, the addition of cisplatin to adjuvant radiation numerically increased RFS and OS at 3 years, though those outcomes did not reach statistical significant, and cisplatin also nearly tripled grade 3+ toxicity. So while cisplatin may not become a standard go-to in this population, the numeric improvements may merit consideration for those at the higher end of the intermediate risk spectrum. | Ryu, Ann Oncol 2025