COREPEX Examines Chemotherapy After Pelvic Exenteration

A secondary analysis of the international, multicenter COREPEX study found that adjuvant chemotherapy was associated with improved survival among patients undergoing pelvic exenteration for gynecologic cancers with metastatic pelvic lymph nodes, according to a research letter published in JAMA Network Open.

The study evaluated whether chemotherapy after pelvic exenteration was associated with overall survival (OS), disease-free survival (DFS), and cancer-specific survival (CSS). Eligible patients had cervical, vaginal, vulvar, or endometrial cancer and underwent anterior or total pelvic exenteration between January 1, 2005, and March 31, 2023. Patients were included if they had histologically metastatic pelvic lymph nodes.

Data from 121 patients were analyzed. The median age was 51 years, 88 patients had cervical cancer, 67 underwent surgery at recurrence, and 61 had total pelvic exenteration, 65 had positive lymphovascular space involvement, and 90 had negative margins. Forty-nine patients received adjuvant chemotherapy, while 72 did not. The most common regimen used in 14 patients was carboplatin and paclitaxel, and platinum-based chemotherapy was used in 35 patients.

At a median follow-up of 57.0 months, median DFS was longer among patients who received adjuvant chemotherapy than among those who did not, at 20 months vs 7 months. Median OS was also longer in the adjuvant chemotherapy group, at 28 months vs 10 months, as was median CSS, at 28 months vs 13 months. Multivariable analysis showed adjuvant chemotherapy was independently associated with improved DFS and OS, while pelvic exenteration performed for persistent disease was independently associated with worse DFS and OS.

The authors noted limitations, including the retrospective design, heterogeneous chemotherapy regimens, no toxicity information, and unavailable data on patients who were not fit for chemotherapy because of poor postoperative condition. They also noted that immunotherapy was not used because it was not yet approved in Europe during the study period. The authors concluded that adjuvant chemotherapy was associated with improved survival and a lower risk of recurrence and death in this patient population.

Source: Bizzarri N, Novák Z, Ricotta G, et al. Adjuvant chemotherapy and survival after pelvic exenteration for gynecologic cancers in the COREPEX study. JAMA Netw Open. 2026;9(6):e2620335. doi:10.1001/jamanetworkopen.2026.20335