Abstract
Objectives:To evaluate sites of failure and long-term survival outcomes of locally advanced stage cervical cancer patients who had standard concurrent chemo-radiation (CCRT) versus those along with adjuvant chemotherapy (ACT) after CCRT. Methods:Patients aged 18–70 years who had FIGO stage IIB-IVA without para-aortic lymph node enlargement (excluding by International Federation of Gynecology and Obstetrics (FIGO) 2018 stage IIIC2r), The Eastern Cooperative Oncology Group (ECOG) scores 0–2, and non-aggressive histopathology were randomized to have CCRT with weekly cisplatin followed by observation (arm A) or ACT with paclitaxel plus carboplatin every 4 weeks for 3 cycles (arm B). Results:From 2015-2017, 259 patients were evaluated. The majority of patients were in stage II and had squamous cell carcinoma with a median tumor size of 5 cm. After the median follow-up of 40.87 months, 17.1% of the patients in arm A and 12.3% of the patients in arm B experienced recurrences (p=0.280). Adding all events of failure (persistence/progression/recurrence), treatment failures tended to be lower in arm A than in arm B: 13.2 versus 21.5 % for loco-regional failure (p = 0.076) and 3.9 versus 6.9% for loco-regional failure and systemic failure (p = 0.278). On the other hand, systemic failure tended to be higher in arm A than in arm B: 13.2% versus 6.9% (p =0.094). The 5-year progression-free survival and 5-year overall survival of patients in both arms were not significantly different. Conclusions:ACT with paclitaxel plus carboplatin after CCRT did not improve response or survival of patients compared to CCRT alone. Although systemic failure tended to be lower in patients who had ACT after CCRT than those who had only CCRT, loco-regional failure with or without systemic failure tended to be higher. However, all of these differences were not statistically significant.
Highlights
Cervical cancer is a global health problem of women, with an average age standardized incidence rate of 13.1 per 100,000 women and a death rate of 6.9 per 100,000 women (Ferlay et al, 2019)
The reasons for having no or incomplete concurrent chemo-radiation (CCRT) or adjuvant chemotherapy (ACT) were shown in the Data Supplement of the previous report (Tangjitgamol et al, 2019)
The results from previous studies on the benefit of adjuvant chemotherapy following CCRT in locally advanced cervical cancer (LACC) were inconsistent (Lorvidhaya et al, 2003; Veerasan et al, 2007; Dueñas-González et al, 2011), with inconclusive evidence from a systematic review (Tangjitgamol et al, 2014). These data encouraged our group to investigate the role of ACT in LACC by conducting a trial comparing CCRT or CCRT followed by ACT (Tangjitgamol et al, 2019)
Summary
Cervical cancer is a global health problem of women, with an average age standardized incidence rate of 13.1 per 100,000 women and a death rate of 6.9 per 100,000 women (Ferlay et al, 2019). Chokaew Tovanabutra et al respective average age standardized incidence and death rates per 100,000 women were 16.2 and 9.0 (slightly more than half) for cervical cancer compared to 35.7 and 10.9 (nearly one third) for breast cancer (Ministry of Public Health and Ministry of Education, 2015). This is probably due to a suboptimal screening coverage of the target population, leading to a high proportion of locally advanced and advanced stage diseases at diagnosis (Khuhaprema et al, 2012). Other treatments were added to CCRT i.e. combining targeted agents with chemotherapy, giving neoadjuvant (NACT) or adjuvant chemotherapy (ACT) prior to or after CCRT
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