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Abstract
BackgroundPrevious studies on cervical cancer reported a worse outcome for adenocarcinoma (AC) compared with squamous cell carcinoma (SCC). Nevertheless, standard treatment remains identical. Insight in the impact of histological types on biological behavior and pathological complete response rates might result in a treatment paradigm shift.MethodsClinicopathological characteristics, survival rates and relapse patterns were compared between AC (n = 36) and SCC (n = 143) cervical cancer patients. Pathological response to treatment was evaluated in the patient subgroup treated with neo-adjuvant chemoradiation followed by surgery (NA-CRT group; n = 84).ResultsIn the entire cohort, 5y Disease Specific Survival (DSS) was 97.1 and 84% for AC and SCC respectively (p = 0.150). In the NA-CRT group 5y DSS was 100 and 75.5% for AC and SCC respectively (p = 0.059). Relapse patterns did not differ significantly between AC and SCC in the entire cohort, or in the NA-CRT group. Adenocarcinoma patients treated with NA-CRT showed significantly less pathological complete response compared with SCC patients (AC = 7%, SCC = 43%, p = 0.027).ConclusionsThere were no statistically significant differences regarding relapse and DSS rates between SCC and AC in the entire cohort, or the NA-CRT group. However, a trend to better 5y DSS of AC in the NA-CRT group was observed. This analysis showed significant differences in treatment responses after NA-CRT: patients with AC responded remarkably less to chemoradiation, resulting in a significantly lower pathological complete response rate. These findings imply a need for a paradigm shift in the treatment of cervical AC patients.
Highlights
Previous studies on cervical cancer reported a worse outcome for adenocarcinoma (AC) compared with squamous cell carcinoma (SCC)
Follow-up period, nodal status, depth of invasion and lymphovascular space invasion (LVSI) were similar between both groups (Table 1)
Mean tumor size was significantly larger for SCC (4.3 cm) than AC (3.5 cm) (p = 0.028); ACs were more often stage IB1 (50% versus 25% for SCC; p = 0.007) and well differentiated (31% versus 6% in SCC; p = 0.0001)
Summary
Previous studies on cervical cancer reported a worse outcome for adenocarcinoma (AC) compared with squamous cell carcinoma (SCC). Several studies reported significantly worse survival in patients with AC (compared to SCC) who received definitive radiation (RT) or chemoradiation (CRT) [10,11,12,13]. Others suggest that AC has a worse outcome than SCC when treated with RT compared to RT combined with chemotherapy or surgery [14,15,16,17]. For early-stage cervical cancer patients, radical hysterectomy (followed by CRT in case of high-risk for relapse) is the main treatment approach. Even with the use of image-guided dose-intensified brachytherapy, local relapse arising from CRT-resistant foci is high (3y-local pelvic control rates of 73% up to 96%, depending on stage and treating center) and remains a major cause of treatment failure [19,20,21]. In exchange for an improved overall survival (OS), adding chemotherapy to conventional RT has doubled the risk of severe acute hematological and gastro-intestinal toxicity and tripled platelet toxicity [22]
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