A Multi-Institutional Retrospective Analysis of Oncologic Outcomes for Chinese Patients with Locally Advanced Cervical Cancer Undergoing Platinum-Based Adjuvant Chemotherapy after Concurrent Chemoradiotherapy

Abstract

Concurrent chemoradiotherapy (CCRT) is currently the standard treatment approach for locally advanced cervical cancer. The role of adjuvant chemotherapy (CT) after CCRT in Chinese patients needs further exploration. The aim of this report is to analyze survival outcome, and rates of late complications in locally advanced cervical cancer patients underwent to adjuvant CT after CCRT. This retrospective multicenter study included 695 patients with cervical cancer between 2007 and 2017 at six medical facilities who satisfied the following criteria: FIGO stage IB2, IIA2, IIB-IVA; no history of neoadjuvant CT; and a history of radical radiotherapy (RT) with pelvic external beam RT and intracavitary brachytherapy (ICBT), CCRT with intravenous cisplatin once a week and adjuvant CT with platinum-based regimen for 1-2 cycles. We divide patients according to type of treatment: 478 were submitted to CCRT alone (Group 1), 68 to adjuvant CT after CCRT (Group 2), and 149 to definitive RT alone (Group 3). Kaplan-Meier estimates at 3/5-years were calculated for overall survival (OS), disease-free survival (DFS), progression-free survival (PFS) and distance metastasis-free survival (DMFS). In addition, local recurrence rate (LRR), distant metastasis rate (DMR) and the late toxicity (RTOG) was reported. On the whole series (aged 52.5 ± 9.9 years), 88.5 % had squamous cell carcinoma. Median follow up was 57.8 months, percent of patients per stage IB2 6.0 %, IIA2 12.7 %, IIB 60.4 %, IIIA-IVA 20.9 %. The baseline characteristics of the 3 groups were superimposable. The 3/5-years OS for 3 groups were 88.3 % vs. 88.2 % vs. 91.3 %, 85.1 % vs. 86.8 % vs. 85.9 %, respectively (p > 0.05). The 3/5-years DFS for 3 groups were 82.4 % vs. 83.8 % vs. 81.2 %, 79.9 % vs. 82.4 % vs. 76.5 %, respectively (p > 0.05). The 3/5-years PFS for 3 groups were 81.8 % vs. 85.3 % vs. 81.2 %, 79.1 % vs. 82.4 % vs. 75.8 %, respectively (p > 0.05). The 3/5-years DMFS for 3 groups were 86.8 % vs. 93.3 % vs. 85.2 %, 83.4 % vs. 91.2 % vs. 83.7 %, respectively (p > 0.05). The LRR in Group 2 (2.0 %) was slightly lower than Group 1 (5.9 %) and Group 3 (3.1 %). Group 2 also had the lowest DMR (8.9 %) compared with Group 1 (16.5 %) and Group 3 (16.3 %). The late toxicity G3-G4 morbidity in 3 groups was 4.2 % vs. 8.8 % vs. 1.3 % for lower gastrointestinal tract and 0.2 % vs. 10.3 % vs. 0.0 % for urinary system (p < 0.001). Although the adjuvant CT after CCRT did not improve OS, DFS, PFS and DMFS, it exhibited a lower pelvic recurrence and distant metastasis rates for Chinese patients with locally advanced cervical cancer. Adjuvant CT may be effective in reducing both loco-regional recurrence and distal metastasis, however, increase the risk of late complications for lower gastrointestinal tract and urinary system.