Chemoradiotherapy in combination with radical surgery is associated with better outcome in cervical cancer patients.

Dan Zheng,Zhi-Ping Yuan,Guang-Yuan Zhou,Jia-Lian Chen,Hua-Ping Mou,Peng Diao,Jie Chen,Jing Jiang,Qiu Wang,Chuan-Li Zhang,Li-Shuai Wang,Xiao-Ming Li,Chuan Lin

doi:10.18632/oncotarget.23165

Abstract

ObjectivesTo retrospectively assess the influence of radical surgery following concurrent chemoradiotherapy (CCRT) on outcomes in cervical cancer (CC) patients.MethodsPatients diagnosed with cervical squamous cell carcinoma or adenocarcinoma (FIGO stages IB2 to IIB) at the Yinbin Second People's Hospital between September 2008 and September 2013, were included in this study. Patients were classified into 2 groups based on the treatment received: surgery group (CCRT plus radical surgery) and non-surgery groups (CCRT only). In addition to clinical information, inter-group differences with respect to local control rate (LCR), local recurrence rate (LRR), metastasis rate, overall survival (OS), progress free survival(PFS) and complications were assessed.ResultsA total of 314 patients were included in the analysis. Parametrial invasion, pelvic lymph node metastasis, tumor diameter > 4 cm and presence of residual disease were risk factors for recurrence in the non-surgery group. In patients with risk factors, radical surgery significantly improved their clinical outcome. The 3-year/5-year LCR in the surgery and non-surgery groups was 88.3%/87.4% and 82.3%/77.5%, respectively (P = 0.04). The 3-year/5-year OS rate in the two groups was 87.1%/81.7% and 72.8%/67.3%, respectively (P = 0.001). The 3-year/5-year LRR in the two groups were 11.7%/12.6% and 17.7%/22.5%, respectively (P = 0.04). The metastasis rates in the two groups were 19.9% and 24.8%, respectively (P = 0.09).ConclusionsSurgery following CCRT could improve overall survival and progressfree survival. Radical surgery following CCRT appears to confer significant benefits including an increase in LCRs and decrease in LRR in CC patients with risk factors.

Highlights

Cervical cancer (CC) is the fourth most common cancer worldwide for females, and the seventh most common cancer overall [1]
Radical surgery following concurrent chemoradiotherapy (CCRT) appears to confer significant benefits including an increase in local control rate (LCR) and decrease in local recurrence rate (LRR) in CC patients with risk factors
The present study aims to compare the outcomes between selected patients treated with early radical surgery after CCRT and those treated with CCRT alone

Summary

Introduction

Cervical cancer (CC) is the fourth most common cancer worldwide for females, and the seventh most common cancer overall [1]. Post-radiotherapy radical hysterectomy is a common practice for stage Ib-II CC while another study reported no therapeutic impact in patients achieving CR following CCRT [8, 9]. The maximum toxicity to normal tissues is exceeded for those patients receiving maximum tolerated doses during the initial chemoradiotherapy phase and interstitial implant branchy therapy can be hampered as a result. Surgery following radiotherapy has been shown to confer a survival benefit and lower local recurrence rate in CC patients [8, 10]. It is important to follow a comprehensive treatment strategy for reducing recurrence rates in patients at high-risk for recurrence. The present study aims to compare the outcomes between selected patients treated with early radical surgery after CCRT and those treated with CCRT alone

Objectives

Methods

Results

Conclusion