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Abstract
Introduction/Background For cervical cancer, squamous cell carcinoma (SCC) accounts for 80% of the histopathological diagnoses and adenocarcinoma (AC) approximately 15%. The literature is varied in terms of outcome data for AC subtypes and few comparative studies exist. At present, the recommendation is to use the same treatment regimens. This study aims to compare rates of regression during radical chemoradiation for squamous cell carcinoma versus adenocarcinoma and assess long-term outcomes.
Methodology This retrospective study analysed 233 locally advanced cervical cancer patients treated with external beam radiotherapy ± weekly cisplatin chemotherapy (CCRT) combined with brachytherapy from July 2011 to March 2016. 35 patients with AC histology were identified with sequential MRI scans and then chronologically matched with patients with SCC histology. Tumour regression was compared after propensity score matching (1:1). Tumour volumes were measured on the baseline MRI, after 4–5 weeks EBRT. Treatment outcomes were calculated using Mann Whitney test and Log-rank test.
Results Median follow-up was 38 months (range, 4–83 months). Mean reduction of tumour volume at 4 weeks was less in AC compared to SCC, 70% versus 83% (p=0.0078). Complete radiological response at 3 months post-treatment was also higher in SCC than AC, 80% versus 46% respectively. Although not statistically significant, there was a trend to better 3 years progression free survival at 74% versus 65% (figure 1).
The percentage reduction (Tumour regression) of AC and SCC after CCRT prior to Brachytherapy
Conclusion AC of the cervix responds at a slower rate than SCC to radical chemoradiotherapy, and significantly fewer patients have a complete response at 3 months. Longer follow up and a larger cohort is required to assess whether this translates into inferior long-term survival. Future strategies may include earlier assessment for salvage surgery or neo-adjuvant/adjuvant systemic therapies.
Disclosure Nothing to disclose.
The Progression Free Survival (PFS) curve of patients with SCC and AC
Characteristics of cervical cancer patients with SCC and AC