Reports of Practical Oncology and Radiotherapy · Published 2026-05-04 · DOI 10.5603/rpor.111763
BACKGROUND: To evaluate the association between bevacizumab use and fistula occurrence in patients with metastatic or persistent cervical cancer (CC) treated with definitive chemoradiotherapy (CRT). MATERIALS AND METHODS: We retrospectively analyzed 101 patients with FIGO stage IIB–IVB CC treated with curative-intent CRT between 2017 and 2023. The primary outcome was the incidence of fistula formation, with a focus on the impact of bevacizumab exposure. RESULTS: Fistulas occurred in 7 of 101 patients (6.9%). Among the 13 patients treated with bevacizumab, 4 (30.8%) developed fistulas compared with 3 (3.4%) of 88 not receiving bevacizumab. Univariable analysis showed significant associations with bevacizumab use (OR = 12.59, 95% CI: 2.43–65.38, p = 0.003), and FIGO stage IVB (OR = 21.90, p = 0.001). In multivariable analysis, bevacizumab (AOR = 13.5, 95% CI: 1.84–99.5, p = 0.011) and FIGO stage IV (AOR = 26.7, 95% CI: 2.59–274.4, p = 0.006) remained independent predictors. No fistulas occurred after 2021, coinciding with institutional discontinuation of bevacizumab in metastatic or persistent disease after CRT (p = 0.043). CONCLUSIONS: Bevacizumab use and FIGO stage IV disease were associated with increased risk of fistula formation after definitive CRT. These findings highlight the need for careful treatment planning when considering bevacizumab in previously irradiated patients, particularly in the current era of multimodal therapy.
Abstract from DOAJ. Public domain (CC0 1.0).
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