Comparison of concurrent chemoradiotherapy followed by radical surgery and high-dose-rate intracavitary brachytherapy: a retrospective study of 240 patients with FIGO stage IIB cervical carcinoma

Abstract

Background: The aim of this study was to compare the long-term survival outcome and late toxicity in patients with FIGO (International Federation of Gynecology and Obstetrics) stage IIB cervical carcinoma after two treatment modalities, ie, concurrent chemoradiotherapy followed by radical surgery and concurrent chemoradiotherapy followed by high-dose-rate intracavitary brachytherapy.

Methods: Between November 2004 and November 2011, 240 patients with FIGO stage IIB cervical carcinoma were analyzed, comprising 119 patients treated with concurrent chemoradiotherapy followed by radical surgery (group 1) and 121 patients treated with concurrent chemoradiotherapy followed by high-dose-rate intracavitary brachytherapy (group 2). Local control, overall survival, progression-free survival, and treatment-related complications were compared between the two groups.

Results: The median follow-up duration was 36 months. Concurrent chemoradiotherapy followed by radical surgery showed a survival benefit when comparing group 1 and group 2 (3-year overall survival, 94.9% versus 84.6%, P=0.011; 3-year progression-free survival, 91.0% versus 81.8%, P=0.049, respectively). Three-year local pelvic control was 94.6% in group 1 and 93.3% in group 2 (P=0.325). Prognostic factors in group 1 were: age (≤35 years versus >35 years), 3-year progression-free survival (74.1% versus 90.9%, P=0.037); tumor diameter (≥6 cm versus <6 cm); and 3-year progression-free survival, (60.6% versus 92.9%, P=0.004). Prognostic factors in group 2 were: tumor diameter (≥4 cm versus <4 cm); 3-year overall survival (78.0% versus 94.8%, P=0.043); tumor diameter (≥6 cm versus <6 cm); 3-year progression-free survival (42.9% versus 84.2%, P=0.032); and 3-year overall survival (42.9% versus 87.1%, P=0.013). Further, 50 patients (42.02%) in group 1 and 46 patients (38.02%) in group 2 suffered from late complications. Analysis of the difference in composition of late complications showed that the rate of leg edema was higher in group 1 (35.29% versus 4.96%, P=0.000) while the rate of radiation enteritis was higher in group 2 (30.58% versus 5.04%, P=0.000).

Conclusion: In patients with FIGO stage IIB cervical carcinoma, concurrent chemoradiotherapy followed by radical surgery achieved higher overall survival and progression-free survival rates in comparison with radical radiotherapy associated with concurrent chemotherapy. Tumor diameter could be a common prognostic factor in these two groups of patients.

Keywords: cervical carcinoma; late toxicity; preoperative concurrent chemoradiotherapy; prognostic factors; radical radiotherapy.

Figure 1

Schematic diagram showing treatment procedure for 240 patients in group 1 and group 2. Abbreviations: EBRT, external beam radiotherapy; HDR-ICBT, high-dose-rate intracavitary brachytherapy.

Figure 2

Overall survival and progression-free survival in group 1 and group 2 patients, respectively. Patients in group 1 show a survival benefit in comparison with those in group 2. Three-year overall survival in group 1 was 94.9% and in group 2 was 84.6% (*P=0.011). Three-year progression-free survival in group 1 was 91.0% and in group 2 was 81.8% (* P=0.049). Abbreviations: OS, overall survival; PFS, progression-free survival; CCRT, concurrent chemoradiotherapy; ICBT, intracavitary brachytherapy.

Figure 3

Overall survival and progression-free survival are shown regarding tumor size as a prognostic factor with a boundary of 6 cm in group 1 (A and B) (3-year overall survival, P=0.122; 3-year progression-free survival, P=0.004) and with a boundary of 4 cm in group 2 (C and D) (3-year overall survival, P=0.043; 3-year progression-free survival, P=0.127). Abbreviations: OS, overall survival; PFS, progression-free survival.