A comparative analysis of the efficacy and prognosis of concurrent chemoradiotherapy alone and concurrent chemoradiotherapy after neoadjuvant chemotherapy for stageⅡB-ⅢBcervical squamous cell carcinoma / 中华放射肿瘤学杂志

ABSTRACT

Objective To investigate the long-term efficacy and prognosis of concurrent chemoradiotherapy alone and concurrent chemoradiotherapy after neoadjuvant chemotherapy for stage ⅡB-ⅢB cervical squamous cell carcinoma. Methods A retrospective analysis was performed among 171 patients with stage ⅡB-ⅢBcervical squamous cell carcinoma who were admitted to our hospital and had complete follow-up data from February 1,2005 to October 31,2011. Results The median follow-up time was 66 months. There were no significant differences in the 3-or 5-year overall survival rates between the concurrent group and the neoadjuvant group(81.4% vs.75.9%,74.3% vs.67.2%,P=0.469).According to the subgroup analysis,there was no correlation between lymph node metastasis and survival curve(P=0.310,P=0.151).The univariate and Cox multivariate analyses showed that tumor size,lymph node metastasis,and concurrent chemotherapy method were independent prognostic factors for cervical cancer(P<0.05).For the patients with lymph node metastasis, the neoadjuvant group had a significantly higher pelvic local recurrence rate than the concurrent group (P=0.047),while there were no significant differences in mortality,distant metastasis,or long-term adverse reactions between the two groups(all P>0.05).For the patients without lymph node metastasis,the neoadjuvant group had a significantly higher incidence of grade 3-4 bone marrow suppression than the concurrent group (P=0.016), while there were no significant differences in mortality,local recurrence,distant metastasis,or long-term adverse reactions between the two groups (all P>0.05). Conclusions Concurrent chemoradiotherapy alone and concurrent chemoradiotherapy after neoadjuvant chemotherapy achieve similar treatment outcomes in patients with stage ⅡB-ⅢBcervical squamous cell carcinoma,no matter whether they have lymph node metastasis or not. Tumor size,lymph node metastasis,and concurrent chemotherapy method are independent prognostic factors.Neoadjuvant chemotherapy increases the risk of grade 3-4 marrow suppression during concurrent chemoradiotherapy,prolongs irradiation time,and increases the risk of local recurrence.