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Abstract
The importance of the overall treatment time (OTT) has a paradoxical status in the current era of concomitant chemoradiotherapy. The main objective of this nationwide study was to evaluate the correlation between overall treatment duration and clinical outcome in cervical cancer patients treated primarily with curative concurrent chemoradiotherapy (CCRT). In this population-based cohort study, 2,594 patients diagnosed with International Federation of Gynecology and Obstetrics (FIGO) stage I-IVA uterine cervical cancer were studied. Univariate and multivariate analyses of prognostic factors were analyzed using Cox’s proportional hazards models. The median irradiation duration was 59 days. Significant prognostic factors related to poor cancer-specific survival (CSS) and overall survival (OS) included old age, non-squamous cell cancer type, high-grade histology, increased tumor size, advanced FIGO stage, and prolonged OTT. After multivariate analysis, prolonged treatment time remained as a significant factor for poor CSS (hazard ratio, HR = 1.33; p < 0.001) and OS (HR = 1.15; p = 0.05). Further subgroup analysis showed that the 5-year OS rates after a treatment time of ≤ 56 days compared with > 56 days in patients with FIGO stages I-IIB and III-IVA were 70% and 65% (p = 0.002) compared with 43% and 42% (p = 0.67), respectively. Inconclusion, completion of CCRT within 8 weeks is recommended, particularly for patients with FIGO stage I-IIB disease.
Highlights
Before the era of concurrent chemoradiotherapy (CCRT), the overall treatment time (OTT) was considered to be a critical parameter for pelvic control and survival in cervical cancer patients treated primarily with radiotherapy (RT) [1,2,3,4]
A slightly longer waiting time was noted in the subgroup of patients with OTT ≤ 56 days, better cancer-specific survival (CSS) (HR = 1.33, p < 0.001; Table 2) and overall survival (OS) (HR = 1.15, p = 0.05; Table 2) outcome were noted in subgroup of OTT ≤ 56 day
According to Petereit et al, a prolonged OTT of > 55 days was an adverse factor for pelvic control and CSS in a retrospective cohort of 209 cervical cancer patients treated with external beam radiotherapy (EBRT) and low-dose rate brachytherapy [3]
Summary
Before the era of concurrent chemoradiotherapy (CCRT), the overall treatment time (OTT) was considered to be a critical parameter for pelvic control and survival in cervical cancer patients treated primarily with radiotherapy (RT) [1,2,3,4]. CCRT using a cisplatin regimen has been suggested to increase RT sensitivity, thereby increasing the biologically effective dose of RT, and several clinical trials have shown a survival advantage for locally advanced cervical cancer [7,8,9,10]. A treatment time of > 56 days was found to be detrimental to pelvic control but with no effect on distant metastasis or disease-specific mortality [12]. The importance of the OTT has a paradoxical status in the current era of CCRT
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