Pelvic radiotherapy combined with immunotherapy and chemotherapy for stage IVB cervical cancer: a retrospective study

This study aimed to evaluate the efficacy, optimal timing, and safety of incorporating pelvic radiotherapy into chemotherapy and immunotherapy regimens with or without bevacizumab for stage IVB cervical cancer.

A retrospective analysis was conducted on patients with stage IVB cervical cancer treated at Hunan Cancer Hospital between January 2018 and December 2024. Patients were divided according to treatment modality into radiotherapy group A (pelvic radiotherapy + chemotherapy + immunotherapy ± bevacizumab; n = 83), radiotherapy group B (pelvic radiotherapy + chemotherapy ± bevacizumab; n = 45), chemotherapy group A (immunotherapy + chemotherapy ± bevacizumab; n = 19), and chemotherapy group B (chemotherapy ± bevacizumab; n = 29). Efficacy was evaluated every 2 to 3 cycles. Patients without disease progression or with unresolved symptoms from primary local lesions received pelvic radiotherapy plus brachytherapy. Systemic treatments continued for 6 to 8 cycles, followed by maintenance immunotherapy with or without bevacizumab. Maintenance treatment was only provided to patients undergoing immunotherapy. Progression-free survival, overall survival, and adverse reactions were assessed.

A total of 176 patients were evaluated. The median follow-up was 31 months (range; 5-79). Median progression-free survival for the pelvic radiotherapy + immunotherapy + chemotherapy, pelvic radiotherapy + chemotherapy, immunotherapy + chemotherapy, and chemotherapy groups was 15, 12, 7, and 4 months, respectively; similarly, median overall survival was not reached and was 29, 13, and 13 months, respectively. Progression-free survival and overall survival were significantly higher in the radiotherapy groups (all p < .05). Radiotherapy initiated within ≤3 chemotherapy cycles resulted in longer progression-free survival (16 vs 10 months, p = .002) and overall survival (not reached vs 26 months, p = .045). Immunotherapy for >1 year yielded better outcomes (median progression-free survival, 22 months; median overall survival, not reached) than ≤1 year or none (all p < .05). Common adverse events included leukopenia, thrombocytopenia, thyroid dysfunction (23/102), and intestinal perforation (4.7%).

Pelvic radiotherapy combined with chemotherapy and immunotherapy was significantly associated with better progression-free survival and overall survival in stage IVB cervical cancer. Early radiotherapy (≤3 cycles) and immunotherapy for >1 year showed stronger survival associations.