Can chemotherapy boost the survival benefit of adjuvant radiotherapy in early stage cervical cancer with intermediate risk factors? A population based study

2016 ◽  
Vol 143 (3) ◽  
pp. 539-544 ◽  
Author(s):  
Omar Mahmoud ◽  
Lara Hathout ◽  
Sherif G Shaaban ◽  
Mohamed A Elshaikh ◽  
Sushil Beriwal ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cervical Cancer ◽  
Adjuvant Radiotherapy ◽  
Survival Benefit ◽  
Early Stage ◽  
Population Based ◽  
Intermediate Risk ◽  
Population Based Study ◽  
Early Stage Cervical Cancer

Delayed adjuvant radiotherapy in early-stage cervical cancer with intermediate-risk features has a detrimental effect on survival that cannot be corrected by adjuvant chemotherapy.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 6037-6037
Author(s):  
Joyson Kodiyan ◽  
Adel Guirguis ◽  
Hani Ashmalla
Keyword(s):  
Cervical Cancer ◽  
Adjuvant Chemotherapy ◽  
Radical Hysterectomy ◽  
Adjuvant Radiotherapy ◽  
Early Stage ◽  
Positive Margin ◽  
Pelvic Lymphadenectomy ◽  
Intermediate Risk ◽  
Early Stage Disease ◽  
Early Stage Cervical Cancer

6037 Background: GOG-0263 is currently investigating the role of adjuvant chemotherapy (CT) concurrently with radiotherapy (RT) in patients with early stage cervical cancer that underwent radical hysterectomy and pelvic lymphadenectomy harboring intermediate risk features. We used a retrospective database to investigate whether adjuvant chemotherapy significantly influenced overall survival (OS), and whether its effectiveness is influenced by delays in radiotherapy. Methods: All data was obtained from the NCDB (National Cancer Database) and initially contained 115,747 cases of cervical cancer diagnosed between 2004 and 2015. Analyzed patients had early stage disease, received radical hysterectomy with pathologic stage I to IIA, and had intermediate risk features including size greater than 4 cm or lymphovascular invasion. All patients received adjuvant RT with or without CT. Cases with positive margin or nodes, with parametrial extension, or metastasis were excluded. Cases were weighted by inverse probability of treatment (CT) using clinical and socioeconomic variables, and analyzed for OS using multivariate models. Predictors of receiving CT were determined using multivariate logistic regression. Results: The final cohort was 557 patients with median follow-up of 43 months (range, 1.54-143.7). Median survival without CT (n = 244) versus with CT (n = 313) was 42.2 versus 43.9 months (HR 0.81, 95%CI 0.661-0.995, p = 0.045). Median time from diagnosis to RT was 91 days (range, 21-691), and predicted for inferior OS (p = 0.007). No significant interaction existed between RT delay and receipt of CT (p = 0.997). Cases with squamous histology were less likely to receive CT than adenocarcinoma histology (OR 0.345, 95%CI 0.159-0.725, p = 0.006). Conclusions: Poor survival outcomes are observed in patients with early stage cervical cancer harboring intermediate risk features when adjuvant radiotherapy is delayed. This outcome was not corrected by addition of chemotherapy.

Post-operative small pelvic intensity-modulated radiation therapy for early-stage cervical cancer with intermediate-risk factors: efficacy and toxicity

2021 ◽  
Author(s):  
Guangyu Zhang ◽  
Fangfang He ◽  
Li Miao ◽  
Haijian Wu ◽  
Youzhong Zhang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cervical Cancer ◽  
Cancer Patients ◽  
Early Stage ◽  
Intensity Modulated Radiotherapy ◽  
Disease Free Survival ◽  
Intermediate Risk ◽  
Intensity Modulated ◽  
Early Stage Cervical Cancer

Abstract Objective The aim of the present study was to retrospectively evaluate the toxicity and efficacy of post-operative small pelvic intensity-modulated radiotherapy in early-stage cervical cancer patients with intermediate-risk factors. Methods Between 2012 and 2016, 151 patients who had cervical cancer (International Federation of Gynecology and Obstetrics stage I–IIA) with intermediate-risk factors were treated with post-operative small pelvic intensity-modulated radiotherapy. The median dose of 50.4 Gy in 28 fractions with small pelvic intensity-modulated radiotherapy was prescribed to the planning target volume. The intensity-modulated radiotherapy technique used was conventional fixed-field intensity-modulated radiotherapy or helical tomotherapy. Results The median follow-up was 37 months. The 3-year disease-free survival and overall survival rates were 89 and 96%, respectively. A total of 144 patients (95.3%) were alive at the last follow-up. In total, 6 patients (3.9%) had recurrence: locoregional recurrence in 3 patients (2%), distant metastasis in 2 (1.3%), and both in 1 (0.6%). Diarrhoea was the most common acute toxicity. There were no patients suffering from acute or late grade ≥ 3 toxicity. Only 4 patients (2.6%) had late grade 2 toxicities. Conclusions For early-stage cervical cancer patients with intermediate-risk factors, post-operative small pelvic intensity-modulated radiotherapy was safe and well tolerated. The rates of acute and late toxicities were quite satisfactory.

scholarly journals Impact of Adjuvant Radiotherapy on Survival Outcomes in Intermediate-Risk, Early-Stage Cervical Cancer: Analyses Regarding Surgical Approach of Radical Hysterectomy

2020 ◽  
Vol 9 (11) ◽  
pp. 3545
Author(s):  
Se Ik Kim ◽  
Tae Hun Kim ◽  
Maria Lee ◽  
Hee Seung Kim ◽  
Hyun Hoon Chung ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Surgical Approach ◽  
Adjuvant Radiotherapy ◽  
Early Stage ◽  
Disease Recurrence ◽  
Survival Outcomes ◽  
Control Group ◽  
Study Group ◽  
Intermediate Risk ◽  
Early Stage Cervical Cancer

This study aimed to investigate the impact of adjuvant radiotherapy (RT) on survival outcomes in patients with intermediate-risk, early-stage cervical cancer who underwent radical hysterectomy (RH). From the cervical cancer cohorts of two tertiary hospitals, patients with 2009 FIGO stage IB-IIA who underwent primary RH between 2010 and 2018 were identified. Patients with intermediate-risk factors that met the Sedlis criteria were included. Survival outcomes were compared between the patients who received adjuvant RT (study group; n = 53) and those who did not receive adjuvant treatment (control group; n = 30). Compared to the control group, the study group showed significantly better recurrence-free survival (RFS; 5-year survival rate, 85.6% vs. 61.0%; p = 0.009). In multivariate analysis, adjuvant RT was associated with a significantly lower risk of disease recurrence (adjusted HR, 0.241; 95% CI, 0.082–0.709; p = 0.010). In a subgroup that underwent open RH (n = 33), adjuvant RT showed a trend toward improved RFS with borderline statistical significance (adjusted HR, 0.098; 95% CI, 0.009–1.027; p = 0.053). However, in a subgroup of minimally invasive surgery (n = 50), adjuvant RT did not improve RFS. In conclusion, implementation of adjuvant RT significantly reduced the disease recurrence rate in patients with intermediate-risk, stage IB-IIA cervical cancer treated primarily with surgery. Survival benefit from adjuvant RT differed according to the surgical approach.

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