Survival impact of additional chemotherapy after adjuvant concurrent chemoradiation in patients with early cervical cancer who underwent radical hysterectomy

Abstract

Background To determine whether additional chemotherapy after concurrent chemoradiation (CCRT) improves survival outcomes in patients with early cervical cancer who undergo radical hysterectomy (RH). Methods We included high- or intermediate-risk patients from two institutions, with 2009 FIGO stage IB–IIA, who underwent primary RH and pelvic lymphadenectomy between January 2007 and June 2020, and had completed adjuvant CCRT. Survival outcomes were compared between patients who received additional chemotherapy (study group) and those who did not (control group). Results A total of 198 patients were included in this analysis. The study (n = 61) and control groups (n = 137) had similar patient age, histologic cancer type, 2009 FIGO stage, and tumor size. However, minimally invasive surgery was performed less frequently in the study group than in the control group (19.7% vs. 46.0%, P < 0.001). The presence of pathologic risk factors was similar, except for lymph node metastasis, which was more frequent in the study group (72.1% vs. 46.0%; P = 0.001). In survival analyses, no differences in the disease-free survival (DFS; P = 0.539) and overall survival (OS; P = 0.121) were observed between the groups. Multivariate analyses adjusting for surgical approach and other factors revealed that additional chemotherapy was not associated with DFS (adjusted HR, 1.149; 95% CI, 0.552–2.391; P = 0.710) and OS (adjusted HR, 1.877; 95% CI, 0.621–5.673; P = 0.264). The recurrence patterns did not differ with additional chemotherapy. Consistent results were observed in a subset of high-risk patients (n = 139). Conclusions Additional chemotherapy after CCRT might not improve survival outcomes in patients with early cervical cancer who undergo RH.

Analysis of the Role and Mechanism of ZEB1 in Regulating Cervical Carcinoma Progression via Modulating PD-1/PD-L1 Checkpoint

“…However, because of the absence of specific clinical presentations at the initial stage of CC, the disease has always reached the advanced stage when patients are treated. In addition, the indications for surgical treatment are limited by tumor staging, coupled with serious side effects caused by radiotherapy and chemotherapy, causing serious psychological and physiological impacts on women [ 3 ]. Therefore, it is urgent to establish a more effective strategy for early diagnosis and targeted therapy of CC.…”

Impact of different post-operative treatment modalities on long-term outcomes in International Federation of Gynecology and Obstetrics (FIGO) 2018 stage IIICp cervical cancer

“…However, the platinum and taxane combination has been preferred for its response and tolerable toxicities 24 25. In previous studies, the results of additional chemotherapy after concurrent chemoradiation were conflicting and might have been due to inconsistency in agents or regimens administered 9 10. In contrast, the STARS trial and the present study were consistent in the regimens for both concurrent chemoradiation and sequential chemoradiation 11.…”

“…Consolidation chemotherapy is another option that was evaluated in node-positive cervical cancer after radical hysterectomy; it showed improved survival in patients with more than three positive nodes or more than two positive nodes with lymphovascular space invasion and stromal invasion greater than 1/3 10. In another study, Kim et al reported that additional chemotherapy after post-operative concurrent chemoradiation did not improve survival in high- or intermediate-risk patients (disease-free survival, p=0.539; overall survival, p=0.121); however, a significantly higher number of patients with lymph node metastasis were in the study group (72.1%) compared with the control group (46.0%) 9. Although insufficient data suggest the benefit of consolidation chemotherapy, a phase III open-label randomized trial and other retrospective studies reported improved survival in locally advanced cervical cancer 18–21…”

“…10 In another study, Kim et al reported that additional chemotherapy after postoperative concurrent chemoradiation did not improve survival in high-or intermediate-risk patients (disease-free survival, p=0.539; overall survival, p=0.121); however, a significantly higher number of patients with lymph node metastasis were in the study group (72.1%) compared with the control group (46.0%). 9 Although insufficient data suggest the benefit of consolidation chemotherapy, a phase III open-label randomized trial and other retrospective studies reported improved survival in locally advanced cervical cancer. [18][19][20][21] The recently published phase III randomized controlled STARS trial investigated the clinical benefit of radiotherapy, concurrent chemoradiation, or sequential chemoradiation as adjuvant therapy in FIGO 2009 stage IB-IIA cervical cancer (n=1048) with high-or intermediate-risk after radical hysterectomy; the trial showed that sequential chemoradiation significantly improved 3-year diseasefree survival compared with radiotherapy (90% vs 82%, p=0.01) and concurrent chemoradiation (90% vs 85%, p=0.04).…”

“…However, relapse will still occur in about 20–30% of patients 6 8. Consolidation chemotherapy after concurrent chemoradiation is another option that still needs further validation due to heterogenous results in high- or intermediate-risk patients 9 10. The recently published STARS trial comparing different post-operative adjuvant treatments in early-stage cervical cancer reported an improved disease-free survival in patients receiving sequential chemoradiation compared with radiotherapy and concurrent chemoradiation 11.…”