Abstract
BackgroundTo determine whether additional chemotherapy after concurrent chemoradiation (CCRT) improves survival outcomes in patients with early cervical cancer who undergo radical hysterectomy (RH).MethodsWe included high- or intermediate-risk patients from two institutions, with 2009 FIGO stage IB–IIA, who underwent primary RH and pelvic lymphadenectomy between January 2007 and June 2020, and had completed adjuvant CCRT. Survival outcomes were compared between patients who received additional chemotherapy (study group) and those who did not (control group).ResultsA total of 198 patients were included in this analysis. The study (n = 61) and control groups (n = 137) had similar patient age, histologic cancer type, 2009 FIGO stage, and tumor size. However, minimally invasive surgery was performed less frequently in the study group than in the control group (19.7% vs. 46.0%, P < 0.001). The presence of pathologic risk factors was similar, except for lymph node metastasis, which was more frequent in the study group (72.1% vs. 46.0%; P = 0.001). In survival analyses, no differences in the disease-free survival (DFS; P = 0.539) and overall survival (OS; P = 0.121) were observed between the groups. Multivariate analyses adjusting for surgical approach and other factors revealed that additional chemotherapy was not associated with DFS (adjusted HR, 1.149; 95% CI, 0.552–2.391; P = 0.710) and OS (adjusted HR, 1.877; 95% CI, 0.621–5.673; P = 0.264). The recurrence patterns did not differ with additional chemotherapy. Consistent results were observed in a subset of high-risk patients (n = 139).ConclusionsAdditional chemotherapy after CCRT might not improve survival outcomes in patients with early cervical cancer who undergo RH.
Highlights
To determine whether additional chemotherapy after concurrent chemoradiation (CCRT) improves survival outcomes in patients with early cervical cancer who undergo radical hysterectomy (RH)
Para-aortic lymphadenectomy was performed more frequently in the study group with borderline statistical significance (41.0% vs. 27.0%; P = 0.050), but the number of removed lymph node (LN) were similar between the study and control groups (P = 0.235)
Among the patients who did not receive para-aortic lymphadenectomy (n = 136), none was suspicious of para-aortic LN metastasis on preoperative imaging studies
Summary
To determine whether additional chemotherapy after concurrent chemoradiation (CCRT) improves survival outcomes in patients with early cervical cancer who undergo radical hysterectomy (RH). Primary radical hysterectomy (RH) and pelvic lymphadenectomy are the current standard of care for early invasive cervical cancer [5, 6]. Adjuvant pelvic radiation therapy (RT) with concurrent platinum-containing chemotherapy is recommended in patients who have at least one of the following three high-risk factors: positive lymph nodes (LNs), parametrial invasion, and positive resection margins [5, 7]. Adjuvant RT with or without concurrent chemotherapy is recommended in node-negative, margin-negative, and parametria-negative patients, if they have intermediate risk factors that meet the Sedlis criteria [5, 7, 8]. Some physicians often prescribe sequential additional chemotherapy to reduce disease recurrence and especially the development of distant metastases
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