Chemotherapy versus radiotherapy for FIGO stages IB1 and IIA1 cervical carcinoma patients with postoperative isolated deep stromal invasion: a retrospective study

Abstract

BackgroundThe adjuvant treatment for patients with isolated stromal invasion after radical hysterectomy and pelvic lymph node dissection (PLND) in FIGO stage IB1 and IIA1 cervical carcinoma has not been established. This study assessed the survival outcomes and recurrent patterns in this particular group of patients treated with chemotherapy or radiation-based adjuvant therapy.MethodsThe records 133 IB1 and IIA1 postoperative cervical carcinoma patients with histopathology-confirmed isolated deep stromal invasion (DSI) without any other unfavorable pathological finding between June 2010 and March 2013 were analyzed. Sixty-five patients received postoperative adjuvant four to six cycles of cisplatin-based chemotherapy (CT group) and Sixty-eight received postoperative received postoperative adjuvant radiotherapy (RT group). Treatment-related toxicities were evaluated and disease-free survival (DFS) and overall survival (OS) were analyzed using Kaplan-Meier estimates and statistical significance was determined using the log-rank test.ResultsWith a median follow-up of 33.7 months (range 10–62 months), RT group had a significantly improved in DFS rate (P = 0.044), but there was no significant difference in overall survival (P = 0.437). Upon further analysis, patients with outer 1/3 to full-thickness invasion in chemotherapy group exhibited significantly higher recurrence rates compared to the radiotherapy group. Leukocytopenia, nausea and vomiting were the most frequent short-term complications of chemotherapy, whereas colitis/proctitis and cystitis were more frequent in the radiotherapy group (P = 0.000 respectively). No significant differences were found regards to other acute toxicities, including hemoglobin, platelets and ALT/AST, colitis/proctitis, cystitis and dermatitis (P = 0.000 respectively). Fewer late severe side effects in the chemotherapy group were observed compared with the radiation group and significant differences were found at colitis/proctitis, cystitis and dermatitis (P = 0.000 respectively).ConclusionCompared to chemotherapy alone, postoperative RT to FIGO stages IB1 and IIA1 cervical carcinoma patients with isolated DSI can reduce risk of recurrence and with acceptable morbidity.

Impact of adjuvant hysterectomy on prognosis in patients with locally advanced cervical cancer treated with concurrent chemoradiotherapy: a meta-analysis

“…Instead, we performed subgroup analysis according to response after CCRT; AH was not associated with recurrence and mortality in two studies that exclusively included good responders and in one study that exclusively included patients with complete response after CCRT. This supports the current guidelines that do not recommend AH for patients who achieve a complete response [ 5 6 ]. Well-designed clinical trials aimed at patients with residual disease after CCRT are needed to elucidate the therapeutic impact of AH.…”

“…Based on five phase III randomized control trials demonstrating that concurrent chemoradiotherapy (CCRT) improves survival outcome in patients with locally advanced cervical cancer (LACC) [ 4 ], CCRT is accepted as the standard treatment for these patients [ 5 6 ]; however, the 5-year overall survival remains approximately 70%. Investigators have evaluated whether adjuvant hysterectomy (AH) after CCRT contributes to any survival benefit.…”

Comparison between adjuvant chemotherapy and adjuvant radiotherapy/chemoradiotherapy after radical surgery in patients with cervical cancer: a meta-analysis

“…From 2,057 records, 49 papers were identified for detailed full-text review. Finally, 13 studies were included in the meta-analysis [ 19 20 21 22 23 24 25 26 27 28 29 30 31 ]. Fig.…”

Comparison of adjuvant therapy for node‐positive clinical stage IB‐IIB cervical cancer: Systemic chemotherapy versus pelvic irradiation

“…Owing to this toxicity profile which is mostly related to radiotherapy, systemic chemotherapy has been considered as an alternative treatment option for adjuvant therapy after primary surgical treatment for this high‐risk group. While some studies suggested a possible utility of systemic chemotherapy, others concluded that systemic chemotherapy does not improve survival outcome . However, these studies were either performed with relatively small sample sizes or lacked specific data for node‐positive high‐risk disease making the results difficult to adopt.…”

“…While some studies suggested a possible utility of systemic chemotherapy, others concluded that systemic chemotherapy does not improve survival outcome. [9][10][11][12][13][14] However, these studies were either performed with relatively small sample sizes or lacked specific data for nodepositive high-risk disease making the results difficult to adopt.…”