Abstract
Radiotherapy is the standard treatment for cervical cancer, but causes radiotherapy-induced complications. Recently, chemotherapy has been more extensively utilized. Here, we perform a large-scale comparison of chemotherapy and radiotherapy. From 2002 to 2008, 2,268 patients were grouped according to adjuvant radiotherapy or chemotherapy before and/or after surgery, and we compared the 5-year overall survival (OS) and disease-free survival (DFS) rates, recurrence rates, side effects, quality of life (QoL), and sexual activity. There were no significant differences between the treatment groups for the 5-year OS and DFS rates (OS: p = 0.053, DFS: p = 0.095), although marginally improved outcomes were observed in the chemotherapy group (OS: 86.5% vs. 82.8%; DFS: 84.5% vs. 81.4%). However, patients with early-stage disease, clinical response, and younger age had increased 5-year OS and DFS rates following chemotherapy compared to radiotherapy (p<0.05). The chemotherapy group exhibited significantly lower 5-year recurrence and distant failure rates compared to the radiotherapy group (p<0.001 and p = 0.007, respectively). Nausea and vomiting were the most frequent short-term complications of chemotherapy, whereas bowel and urinary complications were more frequent in the radiotherapy group. Compared to the chemotherapy group, patients who received radiotherapy reported a lower QoL, less frequent sexual activity, and more severe menopausal symptoms (p<0.05). Cervical cancer patients treated with chemotherapy, especially those with early-stage disease, clinical responses, and younger ages, have more positive outcomes, fewer complications, better QoL and sexual activity, suggesting that chemotherapy may be a valuable alternative option for selected patients.
Highlights
Cervical cancer is the second most common cancer in women from developing countries and is a leading cause of cancerrelated death in women worldwide [1]
The 2009 International Federation of Gynecology and Obstetrics (FIGO) clinical practice guidelines recommend neoadjuvant chemotherapy for selected patients with stage IB2-IIB cervical cancer [7], and clinical practice confirms that adjuvant chemotherapy significantly suppresses distant metastasis in patients with intermediate and high risk factors [19]. These findings suggest that it is worth re-examining the value of chemotherapy modalities for selected patients, in terms of survival benefits and simultaneously improved quality of life (QoL)
Outcomes The 5-year overall survival (OS) and disease-free survival (DFS) rates were slightly but not significantly higher in the chemotherapy group compared with the radiotherapy group (OS: 86.5% vs. 82.8%, p = 0.053, Fig. 1A; DFS: 84.5% vs. 81.4%, p = 0.095, Fig. 1B)
Summary
Cervical cancer is the second most common cancer in women from developing countries and is a leading cause of cancerrelated death in women worldwide [1]. Several recent studies have demonstrated a survival advantage with the use of concurrent chemoradiotherapy, making this treatment a generally accepted alternative option for patients with stage IB2 and worse diseases in many counties [9], [10]. It is important to consider the possibility of organ damage and the loss of female endocrine ability, in cervical cancer patients who are diagnosed at younger ages and have a high chance of being cured due to early-stage disease. These younger and possibly nulliparous women may expect to live an additional 20–30 years after treatment and may be eager to preserve fertility [15]
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