Survival advantages and complications of adjuvant therapy in early-stage cervical cancer with pelvic node metastasis

Abstract

Background: Patients with early-stage cervical cancer who have pelvic node metastasis usually need adjuvant therapy after surgery for improvement of the length of survival. We attempted to determine the survival advantages and complications associated with different adjuvant therapeutic modalities.

Materials and methods: Eighty-seven patients with clinical stage Ib and IIa cervical cancer were treated with radical hysterectomy from July 1986 through December 1994 were reviewed retrospectively. All had had lymph node metastasis. The patients were divided into three groups according to the different adjuvant therapeutic approaches utilized: radiation (group I, n = 43), chemotherapy (group II, n = 23), and chemoirradiation (group III, n = 21).

Results: There was no significant difference among these three groups in the 5-year relapse-free survival rate (group I: 63%, group II: 62%, group III: 51%, p = 0.785). The recurrence rates among these three groups were found to be similar (group I: 32.6%, group II: 39.1%, group III: 47.6%, p = 0.331). However, most of the recurrence in patients who had received pelvic radiation was at a distant site (group I: 79%, group III: 80%) as compared to the patients who had received chemotherapy only (group II: 33%), and the differences were significant (p = 0.020). The rates of complications, such as severe leukopenia, lymphedema with cellulitis, proctosigmoiditis and ileus, were found to be lower in the chemotherapeutic group.

Conclusion: Although we failed to demonstrate the survival advantages of different adjuvant therapeutic approaches, we still favor chemotherapy as an adjuvant basis because it is the least toxic of the regimens.