Metastasis-directed radiotherapy for oligometastatic cervical carcinoma: Identifying potential beneficiaries

Abstract

Background: The role of metastasis-directed radiotherapy (MDRT) in oligometastatic cervical carcinoma (OCC) remains unclear. This study evaluated clinical outcomes of MDRT in patients with OCC and identified prognostic factors associated with survival. Materials and methods: Patients with OCC who received MDRT between 2019 and 2022 were retrospectively reviewed. Eligible patients had <= 5 metastatic lesions treated using stereotactic ablative radiotherapy (SABR), defined as radiotherapy delivered in <= 5 fractions with a fractional dose of >= 5 Gy. Oligometastatic disease was classified according to the ESTRO-EORTC consensus. Radiologic response, patterns of failure, progression-free survival (PFS), overall survival (OS), and treatment-related toxicities were analyzed. Results: A total of 83 patients with 114 temporally independent MDRT courses delivered using SABR were included. Repeat oligorecurrence was the most common oligometastatic subtype, observed in 35 patients. Lymph nodes were the most frequently treated sites (37 patients, 44.6%). Systemic therapy was administered either before and/or after MDRT in 54 patients (65.1%). With a median follow-up of 20 months, the local control rate was 60.8%, and disease progression predominantly occurred outside the treated fields. The 2-year PFS and OS rates were 14.5% and 62.9%, respectively. In multivariable analysis, oligometastatic disease classification and RT response were independently associated with OS. No grade 3 or higher treatment-related toxicities were observed. Conclusion: MDRT using SABR achieved favorable outcomes with minimal toxicity in OCC. Oligometastatic disease classification may assist in selecting appropriate patients for MDRT under multidisciplinary approach. Prospective studies are warranted to validate these findings and to define optimal MDRT strategies.