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Cervical cancer
2022-RA-1174-ESGO Role of adjuvant therapy in intermediate-risk cervical cancer patients – SCCAN study sub-analysis
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  1. David Cibula1,
  2. Huseyin Akilli2,
  3. Luc RCW van Lonkhuijzen3,
  4. Anna Fagotti4,
  5. Lukáš Dostálek1,
  6. David Isla Ortiz5,
  7. Mehmet Mutlu Meydanli6,
  8. Nadeem R Abu-Rustum7,
  9. Diego Odetto8,
  10. Fabio Landoni9,
  11. Jiri Presl10,
  12. Jaroslav Klat11,
  13. Henrik Falconer12,
  14. Aldo Lopez13,
  15. Ricardo dos Reis14,
  16. Ignacio Zapardiel15,
  17. Rene Laky16,
  18. Constantijne H Mom3,
  19. Nicolò Bizzarri4 and
  20. Ali Ayhan2
  1. 1Gynecologic Oncology Center, Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University and General University Hospital (Central and Eastern European Gynecologic Oncology Group, CEEGOG), Prague, Czech Republic
  2. 2Baskent University School of Medicine Department of gynecology and Obstetrics Division of Gynecologic Oncology, Ankara, Turkey
  3. 3Amsterdam University Medical Centers, Center for Gynecologic Oncology Amsterdam, Amsterdam, Netherlands
  4. 4Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Rome, Italy
  5. 5Gynecology Oncology Center, National Institute of Cancerology Mexico, Mexico City, Mexico
  6. 6Department of Gynecologic Oncology, Zekai Tahir Burak Women’s Health and Research Hospital, University of Health Sciences, Ankara, Turkey
  7. 7Memorial Sloan Kettering Cancer Center, New York, NY
  8. 8Department of Gynecologic Oncology, Hospital Italiano de Buenos Aires, Instituto Universitario Hospital Italiano, Buenos Aires, Argentina
  9. 9University of Milano-Bicocca, Department of Obstetrics and Gynecology, Gynaecologic Oncology Surgical Unit, ASST-Monza, San Gerardo Hospital, Monza, Italy
  10. 10Department of Gynaecology and Obstetrics, University Hospital Pilsen, Charles University in Prague, Pilsen, Czech Republic
  11. 11Department of Obstetrics and Gynecology, Faculty of Medicine, University Hospital and University of Ostrava, Ostrava, Czech Republic
  12. 12Department of Pelvic Cancer, Karolinska University Hospital and Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
  13. 13Department of Gynecological Surgery, National Institute of Neoplastic Diseases, Lima, Peru
  14. 14Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
  15. 15Gynecologic Oncology Unit, La Paz University Hospital – IdiPAZ, Madrid, Spain
  16. 16Gynecology, Medical University of Graz, Graz, Austria

Abstract

Introduction/Background The ‘intermediate-risk’ (IR) group of early-stage cervical cancer patients is characterised by negative pelvic lymph nodes and a combination of tumour-related prognostic risk factors such as tumour size ≥2 cm, presence of lymphovascular space invasion (LVSI), and deep stromal invasion. The role of adjuvant treatment in these patients remains controversial, based on a single randomised GOG 92 study performed more than 20 years ago. The objective of our study was to evaluate if adjuvant (chemo)radiation is associated with a disease-free survival benefit after radical surgery in patients with IR cervical cancer.

Methodology We analysed data from patients who met criteria for intermediate risk cervical cancer (tumour 2–4 cm +LVSI OR tumour size >4 cm; N0; no parametrial invasion; clear surgical margins), underwent primary surgical treatment with a curative intent between 2007 – 2016, and were registered in the international multicentre Surveillance in Cervical CANcer (SCCAN) study. Administration of the adjuvant treatment stratified the cohort in two subgroups in which oncological outcomes were evaluated and compared using log-rank test.

Results Of 692 patients included in the analysis, 274 (39.6%) patients received no adjuvant treatment (AT-) and 418 (60.4%) were treated with adjuvant radiotherapy or chemoradiotherapy (AT+). The 5-year disease-free survival was 83.2% and 80.3% (P=0.365) and corresponding overall survival 88.7% and 89.0% (P =0.281) in AT- and AT+ groups, respectively (figure 1). Separate sub-group analyses in patients with tumour ≥4 cm and 2–4 cm +LVSI also did not reveal any significant survival benefit of combined treatment in either of the sub-groups. Adjuvant (chemo)radiotherapy was not identified as an independent prognostic factor in the cohort or any of the sub-groups.

Abstract 2022-RA-1174-ESGO Figure 1
Abstract 2022-RA-1174-ESGO Figure 1

Disease-free survival (A) and overall survival (B) of intermediate-risk cervical cancer patients divided by administration of adjuvant treatmentAT-: patients did not undergo adjuvant treatment; AT+: patients underwent adjuvant treatment (radiotherapy or chmoradiation). Time 0 marks the day of the surgical treatment

Conclusion Radical surgery alone achieved equal disease-free and overall survival in patients with intermediate-risk, early-stage cervical cancer as compared with combined treatment composed of radical surgery and adjuvant (chemo)radiotherapy.

https://doi.org/10.1136/ijgc-2022-ESGO.96

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