Clinical outcome observation of preoperative concurrent chemoradiotherapy/radiotherapy alone in 174 Chinese patients with local advanced cervical carcinoma

Abstract

Objective: To study outcomes of concurrent chemoradiotherapy (CCRT) or radiotherapy (RT) alone followed by radical surgery in patients with local advanced cervical cancer.

Methods: A retrospective approach was carried out in 174 Chinese patients with International Federation of Obstetricians and Gynaecologists stage IB2-IIIB cervical carcinoma. A total of 121 patients were treated with CCRT, while the remaining 53 patients received RT alone, and the regimen of chemotherapy was weekly cisplatin (40 mg/m2). Pathological response, overall survival (OS), progression-free survival (PFS), and complications were analyzed.

Results: The median age was 45 years and the mean primary tumor diameter was 4.8 ± 1.0 cm. Pathological complete response (CR) was achieved in 53 patients (30.5%). The CR rate was relatively higher in the CCRT group (31.4% vs 28.3%, P = 0.724), particularly when tumor diameter was less than 5 cm (38.2% vs 30.8%, P = 0.623). With median follow-up of 24 months, patients with CR had improved 3-year OS (100% vs 83.6%, P = 0.018) and 3-year PFS (93.1% vs 83.2%, P = 0.035) compared to patients with residual disease. CCRT was associated with significantly improved 3-year PFS (92.0% vs 76.5%, P = 0.032) compared to RT alone in patients with tumor diameter less than 5 cm. Thirty-seven patients (21.3%) experienced more than grade 2 toxicity, and one patient (0.6%) developed grade 3 uronephrosis. Data thus indicated that pathologic response, tumor size, and lymph-node involvement were highly correlated with clinical outcomes of the local advanced cervical disease.

Conclusion: Preoperative CCRT achieved outcomes superior to RT alone, depending on the pathologic response, tumor size and lymph-node involvement as major prognostic factors.

Keywords: concurrent chemoradiotherapy; local advanced cervical carcinoma; pelvic lymphadenectomy; prognostic factors; radical hysterectomy.

Figure 1

Kaplan–Meier survival curves of 174 patients treated with concurrent chemoradiotherapy or radiotherapy alone followed by a radical hysterectomy. Note: The 3-year follow-up indicates that PFS is 90.6% and OS is 93.1%. Abbreviations: OS, overall survival; PFS, progression-free survival.

Figure 2

(A–C) Three major pathological responses, ie, complete response (CR), partial response (PR), and residual carcinoma (RC) in patients treated with preoperative concurrent chemoradiotherapy or radiotherapy alone. CR (A) shows mainly inflammatory cell infiltration, PR (B) shows presence of persistent atypical cells or cervical intraepithelial neoplasia, and RC (C) shows residual tumor tissue or tumor cells in cervical tissue.

Figure 3

Survival curves of progression-free survival (PFS) (A) and overall survival (OS) (B) of local advanced cervical carcinoma patients with pathological complete response, partial response, and residual carcinoma after preoperative concurrent-chemoradiotherapy (CCRT) or radiotherapy (RT)-alone modalities. Notes: The 3-year fellow-up indicates high PFS (94.9%) and OS (100%) in the complete response (CR) group, and low PFS (84.0%) and OS (87.3%) in the residual carcinoma (RC) group. Statistical analysis shows significant differences of PFS and OS between the CR and RC groups (P = 0.035, CR vs RC for 3-year PFS; P = 0.018, CR vs RC for 3-year OS).

Figure 4

Survival curves of 3-year progression-free survival (PFS) (A) and overall survival (OS) (B) in 81 local advanced cervical carcinoma patients with tumor size less than 5 cm and treated with preoperative concurrent-chemoradiotherapy (CCRT) or radiotherapy (RT) alone. Notes: CCRT showed improved 3-year PFS but not OS compared with RT alone. Statistical analysis shows significant differences between CCRT and RT alone (P = 0.032, 92.0% CCRT vs 76.5% RT alone for 3-year PFS; P = 0.055, CCRT vs RT alone for OS).