Efficacy of postoperative concurrent chemoradiotherapy for early-stage cervical adenosquamous carcinoma and adenocarcinoma

Abstract

Objective To investigate the efficacy of postoperative concurrent chemoradiotherapy for early-stage cervical adenosquamous carcinoma and adenocarcinoma. Methods A total of 62 patients with cervical adenosquamous carcinoma, 149 patients with cervical adenocarcinoma, and 2687 patients with cervical squamous cell carcinoma, all of whom were in stage ⅠB-ⅡA and were treated from 2006 to 2012, were enrolled, and some of them received postoperative pelvic radiotherapy±para-aortic extended field radiation±afterloading radiotherapy. The chemotherapy regimen consisting of DDP, TP, and FP was given to these patients. The chi-square test was used for comparison of general clinical data, the Kaplan-Meier method was used for calculating survival rates, and the log-rank test was used for survival difference analysis. Results Cervical adenosquamous carcinoma and adenocarcinoma had no significant differences in clinicopathological features (P=0.107-0.639). The high-risk patients with adenocarcinoma had a higher recurrence rate than their low-risk counterparts even after adjuvant radiotherapy or chemoradiotherapy (P=0.000). In the patients treated with surgery and radiotherapy, those with adenosquamous carcinoma had the shortest median survival time, followed by those with adenocarcinoma and squamous cell carcinoma (P=0.134, 0.787); in the patients treated with surgery and concurrent chemoradiotherapy, those with adenocarcinoma had the shortest median survival time , followed by those with adenosquamous carcinoma and squamous cell carcinoma (P=0.131, 0.643), and the median survival time showed a significant difference between the patients with adenocarcinoma and those with squamous cell carcinoma (P=0.000). In the patients with adenosquamous carcinoma and adenocarcinoma, the patients treated with postoperative concurrent chemoradiotherapy had higher incidence rates of short-term adverse reactions than those treated with postoperative radiotherapy (P=0.037, 0.003), but the incidence rates of long-term adverse reactions showed no difference between the two groups of patients (P=0.861, 0.655). In the patients with adenosquamous carcinoma, the patients treated with postoperative concurrent chemoradiotherapy had a lower rate of distant metastasis (P=0.003) and prolonged median overall survival and disease-free survival (both increased by 17 months)(P=0.811, 0.799), as compared with those treated with postoperative radiotherapy, while in the patients with adenocarcinoma, the median overall survival and disease-free survival were reduced by 11 and 9 months, respectively (P=0.330, 0.115). Conclusions Compared with postoperative radiotherapy, postoperative concurrent chemoradiotherapy for early-stage high-risk cervical adenosquamous carcinoma can reduce the rate of distance metastasis. Compared with radiotherapy, postoperative concurrent chemoradiotherapy for adenosquamous carcinoma and adenocarcinoma cannot improve survival time. Key words: Cervical neoplasms/radiotherapy; Cervical neoplasms/chelmotherapy; Radiochemotherapy, postoperation; Prognosis