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

Abstract

This was a nation-wide retrospective study in Japan examining women who underwent radical hysterectomy for clinical stage IB-IIB cervical cancer with pelvic and/or para-aortic lymph node metastasis between 2004 and 2008. Time to recurrence or death and patterns of disease recurrence were compared based upon the adjuvant treatment pattern: whole pelvic radiotherapy alone (n = 253), concurrent chemoradiotherapy (CCRT, n = 502) and chemotherapy alone (n = 319). Women who received chemotherapy alone had similar recurrence (5-year rates, 36.6% vs. 34.1%, adjusted-hazard ratio [HR] 0.95, 95% confidence interval [CI] 0.70-1.28, P = 0.72) and cervical cancer mortality (24.7% vs. 21.8%, adjusted-HR 0.96, 95% CI 0.67-1.38, P = 0.83) rates compared to those who received CCRT on multivariate analysis. However, when recurrence patterns were stratified, chemotherapy treatment was independently associated with decreased risk of distant recurrence (5-year cumulative rates, 19.2% vs. 24.6%, adjusted-HR 0.47, 95% CI 0.31-0.71, P < 0.001) but increased risk of local recurrence (23.9% vs. 14.3%, adjusted-HR 2.03, 95% CI 1.34-3.08, P = 0.001) compared to CCRT. Non-squamous histology, parametrial involvement and high lymph node ratio were independent predictors for local recurrence, and presence of multiple risk factors was associated with high 5-year cumulative local recurrence rate in the chemotherapy group: no risk factor 3.9%, single factor 14.2-22.1%, and multiple risk factors 27.8-71.9% (P < 0.001). In conclusion, while exhibiting different recurrence patterns, systemic chemotherapy may be as effective a postoperative treatment as radiation-based therapy in node-positive high-risk stage IB-IIB cervical cancer. When tumor exhibits certain risk factors, chemotherapy alone is likely insufficient for local control and adding pelvic irradiation to systemic chemotherapy is recommended in this subgroup.

Significance of Malignant Peritoneal Cytology on the Survival of Women with Early-Stage Cervical Cancer: A Japanese Gynecologic Oncology Group Study

“…The current study validates the results of prior studies in that the presence of malignant cells in pelvic cytology testing at the time of radical hysterectomy is associated with decreased survival in women with early-stage cervical cancer. As prior studies were limited in the sample size (range, 105-448) and the number of malignant peritoneal cytology cases (range, [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27], the findings from our study, which included a larger patient pool, are more reliable for interpretation of the analysis [6][7][8][9][10].…”

“…This is a secondary analysis of a prior nationwide multicenter retrospective study conducted in Japanese Gynecologic Oncology Group (JGOG)-designated institutions [18][19][20][21][22][23][24][25]. The study concept and participation call for this landmark collaborator study was initially announced to all JGOG-designated institutions (182 sites), and 116 (63.7%) of these sites voluntarily participated in this study (JGOG-1072S).…”

“…Detail of the utilized methodology was previously described [18][19][20][21][22][23][24][25]. Briefly, data collection took place at each study site by deploying a universal data entry form for the collection of clinical, tumor, treatment and survival information from archived medical records.…”

“…Cutoff and grouping for the clinico-pathological variables were based on previous studies [18][19][20][21][22][23][24][25]. Definition of hospital surgical volume was based on a prior study: <32 cases for low-volume, 32-104 cases for mid-volume, and ≥105 cases for high-volume over five years [21].…”

Phase II study of adjuvant chemotherapy with paclitaxel and nedaplatin for uterine cervical cancer with lymph node metastasis

“…Several retrospective studies on postoperative adjuvant CT alone have also been reported and all of them conclude that systemic CT alone as postoperative adjuvant therapy could obtain similar or better results compared with RT/CCRT. [18][19][20][21] Matsuo et al 22 In summary, adjuvant CT alone with TN after radical hysterectomy for patients with high-risk early-stage cervical cancer was demonstrated to be an effective and feasible treatment. We suggest that a prospective randomized study be conducted with the aim of testing the noninferiority of systemic CT alone to CCRT as optimal adjuvant therapy for patients with factors placing them at high risk for recurrence.…”