Adjuvant External Beam Radiation Therapy (EBRT) and Paclitaxel Plus Platinum-Based Chemotherapy in Cervical Cancer after Radical Hysterectomy: A Retrospective Study

Abstract

To evaluate the safety and efficacy of adjuvant intensity-modulated radiotherapy (IMRT) /volumetric modulated arc therapy (VMAT) with concurrent paclitaxel plus platinum-based chemotherapy in cervical cancer after radical hysterectomy. Data of 344 patients who were diagnosed with cervical cancer after radical hysterectomy (R0 resection) receiving adjuvant pelvic IMRT/VMAT and paclitaxel plus platinum-based chemotherapy between August 2009 and April 2018 in our institution was analyzed retrospectively. Radiation dose of adjuvant pelvic IMRT/VMRT was 50Gy/25f or 50.4 Gy/28f. Some patients also received additional boost to vaginal cuff of 10.2Gy simultaneous or 9Gy/3f sequentially with EBRT techniques. All patients received 4 cycles of adjuvant paclitaxel plus platinum-based chemotherapy (TP: paclitaxel 135 mg/m2 or 90 mg/m2 (with EBRT concurrently) ivgtt d1 + DDP 70mg/m2 or 50 mg/m2 (with EBRT concurrently) ivgtt d1, q3w; TC: paclitaxel 135 mg/m2 or 90 mg/m2 (with EBRT concurrently) ivgtt d1+ CBP AUC 4-5 ivgtt d1, q3w). The Kaplan-Meier method was used to estimate relapse-free survival (RFS) and overall survival (OS) rates. With univariate analysis and the Cox regression model, we evaluated the association of clinical pathological characteristics with RFS of patients. All patients underwent adjuvant EBRT and chemotherapy. The median cycles of adjuvant chemotherapy were 3 (1-8) cycles. In these patients, 340 patients (98.84%) received chemotherapy with TP regimen, 3 patients (0.87%) received TC regimen, and 1 patient (0.29%) received 1 cycle TP and 1cycle TC. 169 patients (49.1%) received boost to vaginal cuff. There were 4 patients (1.16%) who did not complete planned radiotherapy. With a median follow-up of 34 (3-106) months, the 2- and 3-year RFS were 98.2% and 97.6%, and the 2- and 3- year OS was 96.2% and 94.4%, respectively. The univariate analysis showed that prognostic factors of better DFS was Ki67 < 80% (HR 0.271, 95% CI 0.085-0.866, p=0.028). Twenty-five patients (7.27%) have recurred. Of these, 1 patient was diagnosed with primary lung cancer during follow-up. Sixty-four patients (26.23%) had acute grade 3 hematological adverse events (AE) and 10 (2.91%) had acute grade 4 hematological AE. Most common acute grade 3-4 hematological AE were leucopenia (59 cases, 17.15%) and neutropenia (32 cases, 9.30%). Acute grade 3-4 thrombocytopenia, anemia, and abnormal liver function were observed in 3 patients (0.87%), respectively. Fourteen patients (4.07%) had acute grade 3 gastro- intestinal reactions. In these patients, 6 cases (1.74%) had diarrhea, 4 (1.16%) had radiation proctitis and 4 (1.16%) had rectal pain. Adjuvant EBRT and paclitaxel plus platinum-based chemotherapy is effective and safe in cervical cancer after radical hysterectomy.