Abstract
BackgroundTo investigate the role of radiotherapy (RT) in and to suggest radiotherapeutic strategies for patients presenting with disseminated cervical cancer.MethodsWe retrospectively analyzed 50 patients diagnosed as the disseminated cervical cancer with distant lymph nodal or visceral organ metastasis between September 1980 and August 2012. Patients were divided into two subgroups according to visceral organ metastasis: 35 patients diagnosed with distant lymph node metastasis only (group A) and 15 patients with visceral organ metastasis (group B). All patients received external beam RT to the pelvis (median dose 45 Gy) and high-dose rate intracavitary RT (median dose 30 Gy). Thirty-nine patients (78%) received chemotherapy.ResultsMedian follow-up time was 74 months. The 5-year pelvic control rate (PCR) was 85.8%, and the progression-free survival (PFS), and overall survival (OS) rates were 28.7%, and 36.2%, respectively. The major treatment failure was systemic progression (32 patients, 64%). The 5-year PCRs in groups A and B were 87.4% and 74.7%, respectively (p > 0.05). Meanwhile, PFS and OS rates for group A were significantly better than those for group B (35.3% vs. 13.3%, p = 0.010; and 46.3% vs. 13.3%, p = 0.009, respectively).ConclusionOur data revealed considerable prognostic heterogeneity in disseminated cervical cancer. Even though a high PCR was achieved in patients treated with definitive RT, survival outcomes were dependent on progression of visceral organ metastasis. Therefore, personalized RT and chemotherapy treatment strategies according to the presence of visceral organ metastasis in disseminated cervical cancer patients may help improve clinical outcomes.
Highlights
To investigate the role of radiotherapy (RT) in and to suggest radiotherapeutic strategies for patients presenting with disseminated cervical cancer
Stage IVB cervical cancer is defined by the International Federation of Gynecology and Obstetrics (FIGO) as: a carcinoma that has extended beyond the true pelvis and has spread to distant organs
As the FIGO staging system does not differentiate between locations of lymph node (LN) metastasis in stage IVB cancer, clinicians often face diagnostic difficulties, with metastases to the mediastinal, axillary, or supraclavicular LNs
Summary
To investigate the role of radiotherapy (RT) in and to suggest radiotherapeutic strategies for patients presenting with disseminated cervical cancer. Stage IVB cervical cancer is defined by the International Federation of Gynecology and Obstetrics (FIGO) as: a carcinoma that has extended beyond the true pelvis and has spread to distant organs. Patients with disseminated cervical cancer tend to have very poor prognosis [1], and the treatment of patients with disseminated cervical cancer tends to vary according to disease characteristics, patient symptoms, and physician preference. No consensus has been reached regarding the management of disseminated cervical cancer due to its rarity, and there is a huge heterogeneity in the treatment of disseminated cervical cancer. While systemic or palliative radiotherapy (RT) for pain, bleeding, or discomfort, is usually recommended [2,3,4,5,6], little is known about the most effective
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