Analysis Of Clinical Outcome, Toxicity And Prognosis On Locally Advanced Cervical Squamous Cell Carcinoma With Normal SCCAg Levels Receiving Intensity-Modulated Radiotherapy, Brachytherapy Combined With Concurrent Chemotherapy

Abstract

Though SCCAg could be a useful marker in squamous cell carcinoma, rising of SCCAg is not demonstrated in some patients with squamous cell cancer. This study aimed to assess the clinical outcome, toxicity and prognosis on locally advanced cervical squamous carcinoma with normal SCCAg levels receiving concurrent chemoradiotherapy. A total of 294 patients of locally advanced cervical squamous cell carcinoma with normal SCCAg levels before treatment, FIGO 2018 staging from IB to IIIC2 with a median age of 54 years old, who received concurrent chemoradiotherapy from 2007 to 2016 were evaluated in this study. All patients received intensity-modulated external radiotherapy, high-dose-rate brachytherapy and cisplatin-based concurrent chemotherapy. 57 patients (19.39%) were diagnosed with pelvic lymph node metastasis before treatment, 32 (10.88%) of which were unilateral pelvic lymph node metastasis, and 25 (8.5%) were bilateral pelvic lymph node metastasis. The median survival time was 69.1 months, with 5-year OS, DFS, LCR and DMFS 83.6%, 80.6%, 90.3% and 88.1% respectively. 28 patients (9.52%) had local recurrence and 35 (11.9%) had distant metastasis. 11.56% and 1.02% patients had Grade III acute and late adverse effects in urinary system with 8.16% and 1.02% in gastrointestinal tract. The occurrence of the above for Grade IV were only 0%, 0%, 0% and 0.34%. Grade III acute hematological adverse events in leukocytes and neutrophils, lymphocytes, hemoglobin and platelets were 46.26%, 54.42%, 26.87%, 4.76% and 4.08%. Those of grade IV were 3.06%, 30.95%, 3.40%, 0.68% and 0.00%. Grade III late hematological toxicity, leukocytes, neutrophils, hemoglobin and platelets were 2.72%, 0.68%, 3.06% and 0.34%. Those of grade IV all show as 0.34%. As for prognostic factors, EQD2≥8500cGy (P = 0.001 and 0.008) and the courses of concurrent chemotherapy ≥4 cycles (P = 0.024 and 0.018) substantially improve OS and DFS. The performance of brachytherapy (P = 0.000) effectively improved LCR. While the courses of concurrent chemotherapy ≥ 4 cycles (P = 0.024) acted as an independent prognostic factor for DMFS, pelvic lymph node metastasis was an independent prognostic factor for OS, DFS, LC and DMFS, with metastasis of bilateral pelvic lymph nodes leading to worse prognosis than that of unilateral one. Intensity-modulated radiation therapy combined with brachytherapy and at least 4 courses of concurrent chemotherapy could significantly improve the prognosis including local recurrence and distant metastasis of locally advanced cervical squamous cell carcinoma with normal SCCAg level, and substantially reduce incidence of acute and late adverse effects above grade III. Most importantly, metastasis of pelvic lymph nodes acted as a significant prognosis factor. Among metastases of pelvic lymph nodes, bilateral metastases had a worse prognosis than unilateral ones.