Radical hysterectomy with adjuvant radiotherapy versus radical radiotherapy for FIGO stage IIB cervical cancer

Abstract

BackgroundThe goal of this study was to compare treatment outcomes for Federation of Gynecology and Obstetrics (FIGO) stage IIB cervical carcinoma patients receiving radical surgery followed by adjuvant postoperative radiotherapy versus radical radiotherapy.MethodsMedical records of FIGO stage IIB cervical cancer patients treated between July 2008 and December 2011 were retrospectively reviewed. A total of 148 patients underwent radical hysterectomy with pelvic lymph node dissection followed by adjuvant radiotherapy (surgery-based group). These patients were compared with 290 patients that received radical radiotherapy alone (RT-based group). Recurrence rates, progression-free survival (PFS), overall survival (OS), local control rates, and treatment-related complications were compared for these two groups.ResultsSimilar rates of recurrence (16.89% vs. 12.41%, p = 0.200), PFS (log-rank, p = 0.211), OS (log-rank, p = 0.347), and local control rates (log-rank, p = 0.668) were observed for the surgery-based group and the RT-based group, respectively. Moreover, the incidence of acute grade 3–4 gastrointestinal reactions and late grade 3–4 lower limb lymphedema were significantly higher for the surgery-based group versus the RT-based group. Cox multivariate analyses found no significant difference in survival outcome between the two groups, and tumor diameter and histopathology were identified as significant prognostic factors for OS.ConclusionsRadical radiotherapy was associated with fewer treatment-related complications and achieved comparable survival outcomes for patients with FIGO stage IIB cervical cancer compared to radical hysterectomy followed by postoperative radiotherapy.

Comparison of Lower Extremity Edema in Locally Advanced Cervical Cancer: Pretreatment Laparoscopic Surgical Staging with Tailored Radiotherapy Versus Primary Radiotherapy

“…13 Chai et al showed that the incidence of severe lymphedema (grade 3-4, the National Cancer Institute Common Toxicity Criteria, Version 2.0) was significantly higher in the radical surgery with adjuvant radiotherapy group than in the primary radiotherapy group (6.76 vs. 2.07 %; P = 0.017). 14 The more prevalent and prolonged LEE and lymphedema in Group 1 in the current study might be explained by the synergistic effect of LND and radiotherapy on the advent of lower-limb lymphedema. LND directly damages the lymphatic system, resulting in lymphatic drainage disruption, and irradiation worsens this damage by accelerating fibrosis and preventing the formation of collateral circulation.…”

“…13,14 Although not a primary outcome, several observational studies reported the differences in lower limb lymphedema among patients with FIGO stage IIB cervical cancer. Mabuchi et al showed that the incidence of severe lymphedema (grade 3-4, the National Cancer Institute Cancer Therapy Evaluation Program Common Terminology Criteria for Adverse Events, Version 2.0) was 5.3 % in the radical surgery with adjuvant radiotherapy group and 2.1 % in the primary radiotherapy group.…”

Cost-effectiveness of radical hysterectomy with adjuvant radiotherapy versus radical radiotherapy for FIGO stage IIB cervical cancer

“…A decision-tree model to compare the cost and effectiveness between two primary treatment modalities for FIGO stage IIB cervical cancer patients was constructed using TreeAge Pro software (TreeAge Software Inc., Williamstown, MA, USA) ( Figure 1 ). Treatment arms were compared as defined by Chai et al 5 Surgery-based treatment arm contained 148 patients and consisted of radical hysterectomy combined with adjuvant external beam radiotherapy (EBRT) (1.8 or 2 Gy per fraction, with five fractions administered per week for a total of 25 fractions and 45–50 Gy). Of these patients, 69 patients (46.62%) had one or more risk factors and received TP (paclitaxel and cisplatin) regimen for four cycles.…”

“… 2 – 4 Our previous literature reported that radical radiotherapy was associated with fewer treatment-related complications and achieved a comparable survival outcome compared to radical hysterectomy plus adjuvant radiotherapy for FIGO stage IIB disease. 5 However, all the previous studies reported only progression-free survival, OS, or toxicities, whereas the costs of treatment have rarely been addressed.…”

Nomogram for predicting the overall survival of cervical cancer patients with nonsurgical treatment

“…In 2018, the International Federation of Gynecology and Obstetrics(FIGO) approved the amendment staging system based on cutting-edge researches and discussed the management of cervical cancer based on the system. Although the preferred treatment is surgery, including multiple styles in the early stages [5], radiotherapy has the same effect in local control and survival for patients with contraindications to surgery or anesthesia [8][9][10]. As for locally advanced cervical cancer, concurrent chemoradiotherapy (CCRT) became the recommended treatment following 1999 National Cancer Institute report [5].…”