Clinical outcomes of adjuvant radiation therapy and prognostic factors in early stage uterine cervical cancer

Abstract

PurposeTo evaluate the outcomes of adjuvant radiotherapy (RT) and to analyze prognostic factors of survival in the International Federation of Gynecology and Obstetrics (FIGO) IB-IIA uterine cervical cancer.Materials and MethodsWe retrospectively reviewed the medical records of 148 patients with FIGO IB-IIA uterine cervical cancer who underwent surgery followed by adjuvant RT at the Yonsei Cancer Center between June 1997 and December 2011. Adjuvant radiotherapy was delivered to the whole pelvis or an extended field with or without brachytherapy. Among all patients, 57 (38.5%) received adjuvant chemotherapy either concurrently or sequentially. To analyze prognostic factors, we assessed clinicopathologic variables and metabolic parameters measured on preoperative 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT). To evaluate the predictive performance of metabolic parameters, receiver operating characteristic curve analysis was used. Overall survival (OS) and disease-free survival (DFS) were analyzed by the Kaplan-Meier method.ResultsThe median follow-up period was 63.2 months (range, 2.7 to 206.8 months). Locoregional recurrence alone occurred in 6 patients, while distant metastasis was present in 16 patients, including 2 patients with simultaneous regional failure. The 5-year and 10-year OSs were 87.0% and 85.4%, respectively. The 5-year and 10-year DFSs were 83.8% and 82.5%, respectively. In multivariate analysis, pathologic type and tumor size were shown to be significant prognostic factors associated with both DFS and OS. In subset analysis of 40 patients who underwent preoperative PET/CT, total lesion glycolysis was shown to be the most significant prognostic factor among the clinicopathologic variables and metabolic parameters for DFS.ConclusionOur results demonstrated that adjuvant RT following hysterectomy effectively improves local control. From the subset analysis of preoperative PET/CT, we can consider that metabolic parameters may hold prognostic significance in early uterine cervical cancer patients. More effective systemic treatments might be needed to reduce distant metastasis in these patients.

The Prognostic Impact of the Number of Metastatic Lymph Nodes and a New Prognostic Scoring System for Recurrence in Early-Stage Cervical Cancer with High Risk Factors: A Multicenter Cohort Study (KROG 15-04)

“…ADC in cervix cancer has been considered to have biological aggressiveness and to be more resistant to adjuvant treatment [ 25 , 26 ]. In the present study, ADC histology carried a poor prognosis with 71.8% of DMFS and 61.8% of DFS at 5 years compared to SqCC with 87.7% of DMFS and 84.1% of DFS at 5 years, respectively.…”

Nomogram Predicting Overall Survival in Operable Cervical Cancer Patients

“…28,29 The size and histological type of tumor were reported to be associated with poor OS and disease free survival in cervical cancer. 30,31 Grigsby et al 32 enrolled 1239 cervical cancer patients and demonstrated the survival rates of squamous cell carcinoma patients were similar to those of adenocarcinoma. Bradley et al retrospectively reviewed data from 335 women in stage II to IV who received weekly cisplatin and radiation.…”

Radiographic Number of Positive Pelvic Lymph Nodes as a Prognostic Factor in Cervical Cancer Treated With Definitive Concurrent Chemoradiotherapy or Intensity-Modulated Radiotherapy

“…Some studies have suggested that the lymph node positivity is one of the most prominent prognostic factors for recurrence and death in patients with cervical cancer ( 15 , 16 ). Conversely, other studies reported conflicting results that positive pelvic lymph nodes (PLNs) do not affect recurrence and survival ( 17 , 18 ). A GOG study about early-stage cervical cancer undergoing surgery showed significantly worse disease free interval between patients with positive pelvic lymph nodes but not survival ( 19 ).…”