J Gynecol Oncol.  2009 Sep;20(3):146-150. 10.3802/jgo.2009.20.3.146.

Prognostic significance of neutropenia during adjuvant concurrent chemoradiotherapy in early cervical cancer

• Kim YH
• Chung HH
• Kim JW
• Park NH
• Song YS
• Kang SB

• KMID: 2173446
• DOI: http://doi.org/10.3802/jgo.2009.20.3.146

Abstract

OBJECTIVE
To evaluate the prognostic significance of adjuvant concurrent chemoradiotherapy-induced neutropenia with survival in patients with squamous cell carcinoma of the uterine cervix. METHODS: Data from 107 patients with stage IB-IIB cervical cancer were retrospectively analyzed. The median follow-up was 37.5 (4.2-72.7) months. All patients had received radical surgery, including pelvic lymphadenectomy, followed by paclitaxel plus carboplatin-based concurrent chemoradiotherapy. Relative neutropenia, defined as an absolute neutrophil count <1,000/mm3 at the concurrent chemoradiotherapy cycle nadir, correlated to the pathologic findings and survival outcomes. RESULTS: Sixty-six patients experienced neutropenia at least once during concurrent chemoradiotherapy, and demonstrated marginal improvement in disease-free survival (p=0.055), although not in overall survival. By subgroup analyses, the gain of disease free survival mainly originated from the node metastasis subgroup (p=0.033). Treatment-induced neutropenia proved to be the only significant independent factor for recurrence in cervical cancer (p=0.042) by multivariate analysis. CONCLUSION: Concurrent chemoradiotherapy-induced neutropenia may be a prognostic factor of recurrence in patients with cervical cancer. Individualized dose titration of the tolerable myelosuppression might be beneficial.

Keyword

Uterine cervical cancer; Chemoradiotherapy; Neutropenia; Survival

MeSH Terms

Carcinoma, Squamous Cell
Cervix Uteri
Chemoradiotherapy
Disease-Free Survival
Female
Follow-Up Studies
Humans
Lymph Node Excision
Multivariate Analysis
Neoplasm Metastasis
Neutropenia
Neutrophils
Paclitaxel
Recurrence
Retrospective Studies
Uterine Cervical Neoplasms
Paclitaxel

Figure

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  Fig. 1 Kaplan-Meier curve depicting the disease-free survival (DFS) for neutropenic and non-neutropenic patients. (A) DFS (p=0.055), (B) DFS in cases of lymph node metastasis (p=0.033).

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