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Objective:To investigate the efficacy and adverse reactions of concurrent chemoradiotherapy (CRT) and radiotherapy (RT) alone in the treatment of cervical cancer patients with intermediate-risk factors after operation.Methods:The clinical data of 210 patients with cervical cancer patients after operation in Shanxi Province Cancer Hospital between August 2014 to March 2016 were retrospectively analyzed. The postoperative pathology met the Sedlis standard. All patients were divided into RT alone group (100 cases) and CRT group (110 cases) according to the different adjuvant treatment regimens; and the efficacy and adverse reactions of both groups were also analyzed.Results:The 3-year progression-free survival (PFS) rate was 82.8%, 81.5%, respectively in RT alone group and CRT group ; 5-year PFS rate was 80.6%, 77.4%, respectively in RT alone group and CRT group; and there were no statistically significant differences in the PFS of both groups ( χ2 = 0.29, P = 0.591). The 3-year overall survival (OS) rate was 88.5%, 86.7%, respectively in RT alone group and CRT group; 5-year OS rate was 86.4%,82.6%, respectively in RT alone group and CRT group; and there were no statistically significant differences in the OS of both groups ( χ2 = 0.59, P = 0.443). The local recurrence rate was 8.0% (8/100) and 9.1% (10/110), respectively in RT alone group and CRT group, and the difference was statistically significant ( χ2 = 0.08, P = 0.778); the distant metastasis rate was 11.0% (11/100) and 12.7% (14/110), respectively in RT alone group and CRT group, and the difference was statistically significant ( χ2 = 0.15, P = 0.699); the incidence of bone marrow suppression was 42.0% (42 /100) and 61.8% (68/110), respectively in RT alone group and CRT group, and the difference was statistically significant ( χ2 = 8.25, P < 0.01). The incidence of gastrointestinal reactions was 23.0% (23/100) and 77.3% (85/110), respectively in RT alone group and CRT group, and the difference was statistically significant ( χ2 = 49.94, P < 0.01);the incidence of radiation cystitis was 3.0% (3/100) and 3.6% (4/110), respectively in RT alone group and CRT group, and the difference was statistically significant ( χ2 = 0.06, P = 0.798). The incidence of radiation proctitis was 5.0 %(5/100) and 4.5% (5/110), respectively in RT alone group and CRT group, and the difference was statistically significant ( χ2 = 0.02, P = 0.877). Conclusions:For cervical cancer patients with intermediate-risk factors, CRT shows no survival benefit and increases the incidence of adverse reactions compared with RT alone.
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Cervical cancer is still a common gynecolgical tumor in China. Radical surgery is often the first choice for the treatment of early stage cervical cancer (FIGO stage ⅠB-ⅡA), and postoperative pathological examination often has adverse prognostic factors affecting the survival. According to the NCCN guidelines, patients with cervical cancer who meet Sedlis criteria and have intermediate-risk factors (lymphatic vascular space involvement, tumor size or deep interstitial infiltration) are recommended to receive concurrent chemotherapy with postoperative pelvic external irradiation ± cisplatin. However, the diagnostic criteria, indications and methods of adjuvant therapy for patients with intermediate risk factors after early cervical cancer surgery are still controversial. In this article, research progress on the definition of intermediate risk factors for early cervical cancer after radical hysterectomy and adjuvant treatment was mainly reviewed.
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Objective To compare the prognosis of stage ⅠB-ⅡA cervical squamous cell carcinoma patients with intermediate risk factrs between adjuvant chemotherapy and concurrent chemoradiotherapy, and to explore the safety and effectiveness of adjuvant chemotherapy after surgery. Methods A total of 190 patients treated at the Affiliated Cancer Hospital of Guangxi Medical University were selected and randomly divided into two groups: chemotherapy group (CT group, n=95) and concurrent chemoradiotherapy group (CCRT group, n=95). Ten patients lost to follow-up. Kaplan-Meier method and Log rank test were used for OS calculation and survival curve comparison. Cox proportional-hazards regression model was used for multivariate analysis. Results After a median follow-up of 36.7 months, 190 patients were evaluable. The incidence of G3/G4 blood system toxicity were 3.3% in CT group and 10.11% in CCRT group (P=0.019), the incidence of severe gastrointestinal toxicity were 4.4% in CT group and 17.98% in CCRT group, the incidence of radiation-related response was 22.48%. There was no significant difference in the local recurrence rate or distant recurrence rate between two groups (P > 0.05). There was no statistically significant difference in PFS and OS between two groups (P > 0.05). Conclusion There is no significant difference between postoperative chemotherapy and concurrent chemoradiotherapy on stage ⅠB-ⅡA cervical squamous cell carcinoma patients with intermediate risk facfors, but the adverse reactions of postoperative chemotherapy are significantly reduced compared with concurrent chemoradiotherapy.
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Objective@#To compare the curative effect of postoperative concurrent chemoradiotherapy (CCRT) and radiation therapy (RT) alone on early-stage cervical cancer patients with intermediate-risk factors.@*Methods@#Clinical data of patients with early stage (ⅠB-ⅡA) cervical cancer who underwent radical hysterectomy and pelvic lymphadenectomy in Zhejiang Cancer Hospital between January 2008 and December 2011 were retrospectively analyzed. Cervical squamous cell carcinoma patients with more than two intermediate-risk factors, including lymphatic vascular infiltration, depth of cervical stromal infiltration >1/2 cm or tumor size >4 cm, were screened. Among them, 80 patients were divided into the RT group, 137 patients were divided into the CCRT group. The survivals of these patients were analyzed.@*Results@#At the end of the follow-up period, a total of 22 patients were dead, one patient was alive with neoplasm. There were 23 patients who occurred recurrence/ metastasis, 14 of them were in the RT group and 9 were in the CCRT group. The 5-year progression free survival (PFS) and 5-year overall survival (OS) rate of the entire cohort were 89.9% and 89.8%, respectively. The 5-year PFS rate of RT group was 82.4%, the 5-year PFS rate of CCRT group was 94.1%, and the difference between the two groups was statistically significant (P=0.013). The 5-year OS rate of RT group was 85.1%, the 5-year OS rate of CCRT group was 92.7%, and the difference between the two groups was statistically significant (P=0.049). Univariate analysis showed that therapeutic modality was associated with the 5-year DFS and OS of early-stage cervical cancer patients with intermediate-risk factors (P<0.05). The results of multivariate analysis showed that therapeutic modality was an independent prognostic factor of favorable PFS (RR=3.741, 95% CI: 1.506-9.289, P=0.004) and OS (RR=2.754, 95%CI=1.143-6.637, P=0.024). Neither of the two groups occurred severe anemia. However, the incidence of mild and moderate anemia in the CCRT group was higher than that of RT group (P<0.001). The incidence of leukocytopenia severer than grade Ⅲ in the CCRT group was significantly higher than that of RT group (P<0.001). However, the patients could recover quickly with the treatment of granulocyte colony-stimulating factor.@*Conclusion@#Postoperative CCRT improves the survival of early stage cervical cancer patients with two or more intermediate-risk factors.