Introduction Three-dimensional image-guided brachytherapy (3D-IGBT) has become widespread, improving the outcomes of cervical cancers dramatically. In 2018, the International Federation of Gynecology and Obstetrics (FIGO) staging system for cervical cancer was revised. However, the influence of the revisions on the stage distribution and outcomes of cervical cancers treated with 3D-IGBT remains unclear. To address this issue, we assembled a study cohort that comprised solely of cases treated with definitive radiotherapy using 3D-IGBT and compared the stage distribution and outcomes between the FIGO 2009 and FIGO 2018 staging systems.
Methods Patients with cervical squamous cell carcinoma treated with definitive radiotherapy using 3D-IGBT from 2009 through 2017 were retrospectively collected. The patients were stratified using the FIGO 2009 or 2018 criteria, and survival was analyzed by Kaplan-Meier methods.
Results In 221 patients (median follow-up, 60 months), stage migration occurred in 52.9% of the patients. Patients classified with the 2018 criteria as stage IIICr had the highest proportion (43.8%) of migration, and were mainly from the 2009 stages IIB and IIIB. The 2009 and 2018 schemas showed comparable performance at stratifying 5-year overall survival (OS) and 5-year progression-free survival (PFS) for patients in stages IB–IVA. The 2018 criteria effectively stratified 5-year OS and PFS in the stage III substages. The 5-year OS and PFS for stage IIIC1r patients varied according to tumor T stage.
Conclusion These results provide evidence for the utility of the revised 2018 FIGO staging system in the clinical management of cervical cancers in the 3D-IGBT era.
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