Cancer Res Treat.  2013 Sep;45(3):193-201.

Impact of Chemoradiation on Prognosis in Stage IVB Cervical Cancer with Distant Lymphatic Metastasis

• Kim HS
• Kim T
• Lee ES
• Kim HJ
• Chung HH
• Kim JW
• Song YS
• Park NH

Abstract

PURPOSE
The purpose of this study was to determine whether chemoradiation (CCR) is efficient for improving prognosis, compared with systemic chemotherapy (SC), in patients with stage IVB cervical cancer who have distant lymphatic metastasis.
MATERIALS AND METHODS
Among 2,322 patients with cervical cancer between January 2000 and March 2010, 43 patients (1.9%) had stage IVB disease. After exclusion of 19 patients due to insufficient data and hematogenous metastasis, 24 patients (1%) who received CCR (n=10) or SC (n=14) were enrolled. We compared tumor response, progression-free survival (PFS) and overall survival (OS), and disease recurrence between CCR and SC.
RESULTS
Complete response rates were 60% and 0% after CCR and SC (p<0.01). Grade 3 or 4 leukopenia was more common in patients treated with CCR (24.4% vs. 9.1%, p=0.03), whereas grade 3 or 4 neuropenia was more frequent in those treated with SC (28.4% vs. 11.1%, p=0.03). Development of grade 3 proctitis occurred as a late radiotherapy (RT)-related toxicity in only one patient (10%) treated with CCR. In addition, squamous cell carcinoma and CCR were favorable prognostic factors for improvement of PFS (adjusted hazard ratios [HRs], 0.17 and 0.12; 95% confidence intervals [CIs], 0.04 to 0.80 and 0.03 to 0.61), and only CCR was significant for improvement of OS (adjusted HR, 0.15; 95% CI, 0.02 to 0.90). However, no differences in the rate and pattern of disease recurrence were observed between CCR and SC.
CONCLUSION
CCR may be more effective than SC for improving survival, and can be regarded as a feasible method with some caution regarding late RT-related toxicity for treatment of stage IVB cervical cancer with distant lymphatic metastasis.

Keyword

Chemoradiation; Drug therapy; Lymphatic metastasis; Uterine cervical neoplasms

MeSH Terms

Carcinoma, Squamous Cell
Disease-Free Survival
Humans
Leukopenia
Lymphatic Metastasis
Neoplasm Metastasis
Proctitis
Prognosis
Recurrence
Uterine Cervical Neoplasms

Figure

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  Fig. 1 Kaplan-Meier analyses with the log-rank or Breslow test for progression-free and overall survival in 24 patients with stage IVB cervical cancer: (A) chemoradiation (CCR) vs. systemic chemotherapy (SC), (B) squamous vs. non-squamous cell carcinoma, (C) complete response (CR) vs. non-CR.

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