Journal article
The role of obesity in treatment planning for early-stage cervical cancer
Gynecologic oncology, v 181, pp 60-67
Feb 2024
PMID: 38134755
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Optimal management of obese patients with early-stage cervical cancer is debated despite evidence of non-inferior survival in obese patients undergoing radical hysterectomy with pelvic lymphadenectomy (RH) compared to primary radiation with or without radiosensitizing chemotherapy (RT). Objectives included describing patient factors affecting disposition to RH versus RT; comparing RH outcomes for obese (BMI >30 mg/m2) and non-obese patients; and comparing differences in recurrence free survival (RFS) and overall survival (OS).
This was a single institution cohort study of all cervical cancer patients who underwent RH or were candidates for RH based on clinical stage. Demographic, clinicopathologic and treatment outcomes were collected and analyzed.
RT patients (n = 39, 15%) had a higher BMI (p = 0.004), older age (p < 0.001), more life-limiting comorbidities (LLC) (p < 0.001), larger tumor size (p = 0.001), and higher clinical stage (p = 0.013) compared to RH patients (n = 221, 85%). On multivariable survival analysis there was no difference in OS based on treatment modality; significant predictors of worse OS were larger tumor size, higher number of LLC and recurrence. Among the RH group, obese patients had a longer operative time (p = 0.01) and more LLC (p = 0.02); there were no differences in demographic or clinicopathologic characteristics, operative outcomes, RFS or OS compared to non-obese patients.
In this cohort of RH-eligible cervical cancer patients, BMI was independently associated with disposition to RT. Studies demonstrate that RH is feasible and safe in obese patients with no difference in RFS or OS when compared to non-obese patients. Thus, the decision for disposition to RT should not be based on obesity alone.
•The preferred treatment of early-stage cervical cancer in patients with obesity is undefined.•Obesity is associated with disposition to primary radiation therapy in patients who are candidates for radical hysterectomy.•This study and previous have indicated safety and feasibility of radical hysterectomy in carefully selected obese patients.•Though radical hysterectomy in obese patients may be more technically difficult, outcomes are not different.•The decision for disposition to radiation therapy in early-stage cervical cancer should not be based on obesity alone.
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Details
- Title
- The role of obesity in treatment planning for early-stage cervical cancer
- Creators
- Taylor A. Rives - Magee-Womens HospitalTaylor J. Orellana - Division of Gynecologic Oncology, Magee-Women's Hospital of UPMC, Pittsburgh, PA, United States of AmericaBrigid S. Mumford - Magee-Womens HospitalPaniti Sukumvanich - Magee-Womens HospitalMadeleine Courtney-Brooks - Division of Gynecologic Oncology, Magee-Women's Hospital of UPMC, Pittsburgh, PA, United States of AmericaJessica Berger - Magee-Womens HospitalJason Conger - Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Women's Hospital of UPMC, Pittsburgh, PA, United States of AmericaJohn A. Vargo - UPMC Hillman Cancer CenterSushil Beriwal - Magee-Womens HospitalJamie Lesnock - Magee-Womens HospitalLi Wang - University of PittsburghBrian C. Orr - MUSC Hollings Cancer CenterSarah E. Taylor - Magee-Womens Hospital
- Publication Details
- Gynecologic oncology, v 181, pp 60-67
- Publisher
- Elsevier
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Radiation Oncology (and Nuclear Medicine)
- Web of Science ID
- WOS:001145263800001
- Scopus ID
- 2-s2.0-85180563210
- Other Identifier
- 991021897260304721
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- Collaboration types
- Domestic collaboration
- Web of Science research areas
- Obstetrics & Gynecology
- Oncology