Adjuvant Chemotherapy After Concurrent Chemoradiotherapy for Pelvic Lymph Node-Positive Cervical Squamous Cell Carcinoma

Abstract

Distant metastasis predominates the failure pattern of patients with pelvic lymph node (PLN)-positive cervical cancer. This study evaluated whether adjuvant chemotherapy (ACT) yields better treatment outcomes than observation after concurrent chemoradiotherapy (CCRT) for patients with (PLN)-positive cervical squamous cell carcinoma (SCC). The records of 159 patients with PLN-positive cervical SCC treated with CCRT between March 2007 and February 2018 were retrospectively reviewed. Patients with metastatic para-aortic lymph nodes and/or distant metastasis were excluded. The ACT regimens consisted of 5-Fluorouracil plus cisplatin and paclitaxel plus cisplatin. Treatment outcomes were compared according to the use of ACT before and after propensity score matching. Among the 159 eligible patients, 141 patients (88.7%) underwent CCRT and 42 patients underwent a median of 2 ACT cycles (range: 1-6 cycles) using cisplatin-based doublet chemotherapy. The median follow-up period was 33.8 months (range: 2.9-113.0 months). In multivariate analysis, poor overall survival was independently predicted by larger PLN size (≥15mm) and common iliac lymph node involvement. After propensity score matching, none of the patients was over 65 years old. The ACT group had non-significantly better estimated 3-year rates of overall survival (83.0% and 63.7%, p = 0.173), progression-free survival (80.2% and 60.4%, p = 0.071), local control (94.0% and 81.9%, p = 0.123), as well as a significantly better estimated 3-year rate of distant metastasis-free survival (DMFS) (85.9% and 60.1%, p = 0.040). Grades 3-4 neutropenia were significantly more common in the ACT group (38.1% versus 17.9%, p = 0.008). ACT significantly improved DMFS and tended to improve progression-free survival with tolerable toxicities in patients with PLN-positive cervical SCC. Further studies are needed to verify these findings and clarify the relationship between PLN involvement and prognosis in patients with cervical cancer.