Obstet Gynecol Sci.  2017 Nov;60(6):549-557. 10.5468/ogs.2017.60.6.549.

A retrospective comparison of outcome in IB2 and IIA cervical cancer patients treated with primary concurrent chemoradiation versus radical hysterectomy with or without tailored adjuvant therapy

• Jang TK
• Shin SJ
• Chung H
• Kwon SH
• Cha SD
• Lee E
• Shin C
• Cho CH

• KMID: 2418356
• DOI: http://doi.org/10.5468/ogs.2017.60.6.549

Abstract

OBJECTIVE
The aim of our study is to compare the overall survival (OS), progression-free survival (PFS), and treatment-related morbidities between primary concurrent chemoradiation therapy (CCRT) vs. radical hysterectomy (RH) with or without tailored adjuvant therapy in patients with stages IB2 and IIA cervical cancer.
METHODS
This was a retrospective study of 113 patients with IB2 or IIA cervical cancer treated with either primary CCRT (n=49) or RH (n=64) with or without tailored adjuvant therapy between 2002 and 2011 at Keimyung University Dongsan Medical Center. Patients in RH group was divided into those undergoing surgery alone (n=26) and those undergoing surgery with adjuvant therapy (n=38).
RESULTS
The median follow up period was 66 months. The 5-year OS by treatment modality was 88.7% for the 64 patients in the RH group and 72.8% for 49 patients in the CCRT group (P=0.044). The 5-year PFS was 82.3% and 65.6% after RH group and CCRT group (P=0.048), respectively. Grade 3-4 complication was less frequent after RH alone (7.7%) than RH with adjuvant therapy (34.2%) or CCRT group (28.6%) (P=0.047).
CONCLUSION
The RH group seems to be superior to the CCRT group in oncologic outcomes. However, considering the selection bias including tumor size, lymph node meta, and parametrial invasion in pretreatment magnetic resonance imaging, both treatment modalities are reasonable and feasible in cervical cancer IB2 and IIA. It is important to choose the appropriate treatment modality considering the age and general condition of the patient. Randomized controlled study is needed to confirm the result of our study and determine the optimal treatment.

Keyword

Cervical cancer; Concurrent chemoradiotherapy; Hysterectomy

MeSH Terms

Chemoradiotherapy
Disease-Free Survival
Follow-Up Studies
Humans
Hysterectomy*
Lymph Nodes
Magnetic Resonance Imaging
Retrospective Studies*
Selection Bias
Uterine Cervical Neoplasms*

Figure

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  Fig. 1 (A, B) Kaplan-Meier curves of progression-free survival (PFS) and overall survival (OS) by treatment group. Concurrent chemoradiation (CCRT) vs. radical hysterectomy (RH). (C, D) Kaplan-Meier curves of PFS and OS by treatment group. CCRT vs. RH alone vs. RH followed by tailored therapy.

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