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Impact of the Addition of Concurrent Chemotherapy to Pelvic Radiotherapy in Surgically Treated Stage IB1-IIB Cervical Cancer Patients With Intermediate-Risk or High-Risk Factors: A 13-Year Experience
  1. Mika Okazawa*,
  2. Seiji Mabuchi, MD, PhD,
  3. Fumiaki Isohashi,
  4. Osamu Suzuki§,
  5. Yasuo Yoshioka,
  6. Tomoyuki Sasano,
  7. Yukinobu Ohta*,
  8. Shoji Kamiura*,
  9. Kazuhiko Ogawa and
  10. Tadashi Kimura
  1. *Department of Gynecology, Osaka Medical Center for Cancer andCardiovascular Diseases;
  2. Departments of Obstetrics and Gynecology, and
  3. Radiation Oncology, Osaka University Graduate School ofMedicine; and
  4. §Department of Radiation Oncology, Osaka MedicalCenter for Cancer and Cardiovascular Diseases, Osaka, Japan.
  1. Address correspondence and reprint requests to Seiji Mabuchi, MD, PhD, Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan. E-mail: smabuchi{at}gyne.med.osaka-u.ac.jp.

Abstract

Objectives To identify groups of patients who derive clinical benefit from postoperative adjuvant concurrent chemoradiotherapy (CCRT), we retrospectively investigated the survival outcomes of surgically treated early-stage cervical cancer patients.

Methods We reviewed the medical records of 316 patients with FIGO stage IB1-IIB cervical cancer who had been treated with adjuvant radiotherapy (RT) (n = 124, RT group) or adjuvant CCRT (n = 192, CCRT group) after radical hysterectomy between January 1996 and December 2009. Of these, 187 patients displayed high-risk prognostic factors (high-risk group), and 129 displayed intermediate-risk prognostic factors (intermediate-risk group). Sixty patients with 1 intermediate-risk prognostic factor who received no adjuvant therapy were also identified and used as controls (NFT group). Survival was calculated using the Kaplan-Meier method and compared using the log-rank test.

Results In the high-risk group, adjuvant CCRT was significantly superior to RT alone with regard to recurrence rate, progression-free survival (PFS), and overall survival. In the intermediate-risk group, CCRT was superior to RT with regard to recurrence rate and PFS in patents with 2 or more risk factors. Among the patients with only 1 intermediate-risk factor, although no survival benefit of CCRT over RT was observed, addition of adjuvant treatment resulted in significantly improved PFS compared with the NFT group in patients with deep stromal invasion (log-rank, P = 0.012).

Conclusions Postoperative CCRT improved the prognosis of FIGO stage IB1-IIB cervical cancer patients in the high-risk group and patients who displayed 2 or more intermediate-risk factors. Patients who displayed deep stromal invasion alone also derived clinical benefit from adjuvant treatment.

  • Cervical cancer
  • Radical hysterectomy
  • Concurrent chemoradiotherapy
  • Survival

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Footnotes

  • Mika Okazawa and Seiji Mabuchi contributed equally to this study.

  • This work was supported in part by Grant-in-aid for General ScientificResearch No. 23592446 from the Ministry of Education,Culture, Sports, Science, and Technology of Japan.

  • The authors declare no conflicts of interest.