Abstract
Simple SummaryPelvic nodal involvement is frequently present in early-stage cervical cancer patients on pretreatment imaging studies. However, it is unclear whether radical chemoradiotherapy (CRT) or radical hysterectomy RH followed by tailored adjuvant radiotherapy is more appropriate in these patients. We compared oncological outcomes of up-front surgery followed by tailored adjuvant radiotherapy and definitive CRT in these patients. We found no differences in outcomes existed between definitive CRT and hysterectomy with tailored adjuvant radiotherapy. However, after surgery, 88.7% of patients required adjuvant radiotherapy. These findings suggest that definitive CRT can avoid unplanned tri-modality therapy without compromising oncologic outcomes.To compare the oncologic outcomes between chemoradiotherapy (CRT) and radical hysterectomy followed by tailored adjuvant therapy in patients with early cervical cancer presenting with pelvic lymph node metastasis. We retrospectively analyzed the medical records of women with early cervical cancer presenting with positive pelvic nodes identified on pretreatment imaging assessment. Propensity score matching was employed to control for the heterogeneity between two groups according to confounding factors. Overall survival, disease-free survival, and pattern of failure were compared between the two groups. A total of 262 patients were identified; among them, 67 received definitive CRT (group A), and 195 received hysterectomy (group B). Adjuvant therapy was administered to 88.7% of group B. There were no significant differences between group A and group B regarding the 5-year overall survival rates (89.2% vs. 89.0%) as well as disease-free survival rates (80.6% vs. 82.7%), and patterns of failure. Distant metastasis was the major failure pattern identified in both groups. In multivariate analysis, non-squamous histology was significantly associated with poorer overall survival. As there are no significant differences in 5-year OS, DFS, and patterns of failure, definitive CRT could avoid the combined modality therapy without compromising oncologic outcomes.
Highlights
Definitive chemoradiotherapy (CRT) and radical hysterectomy followed by tailored adjuvant therapy are both suitable treatment modalities in patients with early-stage cervical cancer [1]
Definitive CRT is preferred for patients with a bulky tumor or for those in an inoperable condition, and it is recommended for patients expected to require additional adjuvant therapy, which increases the risk of treatment-related morbidity
There is currently no definitive consensus regarding whether definitive CRT or radical hysterectomy followed by adjuvant therapy would be more appropriate in these patients
Summary
Definitive chemoradiotherapy (CRT) and radical hysterectomy followed by tailored adjuvant therapy are both suitable treatment modalities in patients with early-stage cervical cancer [1]. Radical hysterectomy followed by adjuvant therapy is the preferred treatment strategy for early-stage cervical cancer patients, for patients with a non-bulky tumor or for those who want to preserve ovarian function [2]. Previous studies reported that 30–60% of patients required adjuvant therapy after surgery, which led to an increase in the risk of higher morbidity [4,5,6]. Definitive CRT is preferred for patients with a bulky tumor or for those in an inoperable condition, and it is recommended for patients expected to require additional adjuvant therapy, which increases the risk of treatment-related morbidity. There is currently no definitive consensus regarding whether definitive CRT or radical hysterectomy followed by adjuvant therapy would be more appropriate in these patients
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