Comparison of Postoperative Adjuvant Chemotherapy and Concurrent Chemoradiotherapy for FIGO2018 Stage IIIC1 Cervical Cancer: A Retrospective Study.

Masahiro Kagabu,Yasuko Fukagawa,Tsukasa Baba,Shunsuke Tatsuki,Takayuki Nagasawa,Eriko Takatori,Yoshitaka Kaido,Tadahiro Shoji,Hidetoshi Tomabechi

doi:10.3390/medicina57060548

Masahiro Kagabu, Yasuko Fukagawa + Show 7 more

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https://doi.org/10.3390/medicina57060548

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Abstract

Background and Objectives: In October 2018, the International Federation of Gynecology and Obstetrics (FIGO) revised its classification of advanced stages of cervical cancer. The main points of the classification are as follows: stage IIIC is newly established; pelvic lymph node metastasis is stage IIIC1; and para-aortic lymph node metastasis is stage IIIC2. Currently, in Japan, radical hysterectomy is performed in advanced stages IA2 to IIB of FIGO2014, and concurrent chemoradiotherapy (CCRT) is recommended for patients with positive lymph nodes. However, the efficacy of CCRT is not always satisfactory. The aim of this study was to compare postoperative adjuvant chemotherapy (CT) and postoperative CCRT in stage IIIC1 patients. Materials and Methods: Of the 40 patients who had undergone a radical hysterectomy at Iwate Medical University between January 2011 and December 2016 and were pathologically diagnosed as having positive pelvic lymph nodes, 21 patients in the adjuvant CT group and 19 patients in the postoperative CCRT group were compared. Results: The 5 year survival rates were 77.9% in the CT group and 74.7% in the CCRT group, with no significant difference. There was no significant difference in overall survival or progression-free survival between the two groups. There was no significant difference between CT and CCRT in postoperative adjuvant therapy in the new classification IIIC1 stage. Conclusions: The results of the prospective Japanese Gynecologic Oncology Group (JGOG) 1082 study are pending, but the present results suggest that CT may be a treatment option in rural areas where radiotherapy facilities are limited.

Highlights

Cervical cancer is the seventh most common cancer in humans and the fourth most common cancer in women
concurrent chemoradiotherapy (CCRT), and the other 21 patients were treated with CT
This paper is the first comparison of CCRT and CT in FIGO2018 stage IIIC1 cervical cancer

Summary

Introduction

Cervical cancer is the seventh most common cancer in humans and the fourth most common cancer in women. Database in 2018, the global incidence of cervical cancer was approximately 569,000, and the global mortality was 311,000 [1]. The major change point from the prior 2014 FIGO staging system is the incorporation of lymph node status into stage III disease staging. Patients with early-stage cervical cancer require radical hysterectomy with pelvic lymphadenectomy in Japan. Postoperative radiation therapy can cause severe adverse events for a long time. It is distressing for adverse events in the gastrointestinal tract, significantly reducing the quality of life of patients [3,4]. Matoda et al evaluated the efficacy of adjuvant CT with irinotecan (CPT-11)/nedaplatin (NDP) in patients with positive postoperative lymph nodes [5]. Their report showed that 2 year and 5 year relapse-free survival (RFS) rates were 87.1% and 77.2%

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