Adjuvant combination chemotherapy and radiotherapy versus radiotherapy alone in the treatment of early stage cervical cancer after radical hysterectomy

Abstract

5156 Background: This study was conducted to retrospectively evaluate the benefits and risks of adjuvant pelvic radiotherapy (RT) versus combination pelvic radiotherapy and chemotherapy (RCT) in the treatment of early stage cervical cancer patients with adverse prognostic factors following radical hysterectomy and pelvic lymphadenectomy. Methods: Fifty patients were eligible for inclusion. Adverse prognostic factors were identified as: stromal invasion greater than half the cervical length, lymphovascular space involvement, lower uterine segment involvement, positive resection margins, positive margins with 5mm of resection, positive parametrial margins, clinical tumor diameter greater than half the cervical size, and positive pelvic lymph nodes. All patients were diagnosed and treated at a single institution from 1992–2002. Results: Twenty-nine patients were treated with adjuvant RT and 21 patients were treated with adjuvant RCT. Progression free interval was 62.9 months in the adjuvant RT group compared to 30.4 months in the RCT group. The 2-year survival in the RT group was 96.6% versus 81% in the RCT group. Overall survival was 69 months in the adjuvant RT group versus 35 months in those treated with RCT. Eight (27.5%) patients recurred in the RT group and 10 (47.6%) recurred in the RCT group: 8 (27.5%) patients had pelvic recurrence in the RT group; 7 (33.3%) patients recurred locally in the RCT group. Five patients died in the RT group, 4 (13.8%) of disease; 6 (28.6%) patients died of disease in the RCT group; none died of treatment related complications. Grade 3 toxicity was experienced in 24.1% of the patients who received adjuvant RT compared to 28.6% in the RCT group. Conclusions: There was no increase in overall survival and progression free interval by the addition of adjuvant chemotherapy to irradiation. Consideration should be given to limiting chemotherapy administration due to its adverse side effects and cost without a decrease in cancer recurrence or mortality. Further information for treatment with adjuvant chemotherapy in addition to adjuvant irradiation should be obtained from randomized controlled trials. No significant financial relationships to disclose.