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TOPLINE:

For patients with early-stage cervical cancer without any high-risk factors, postoperative radiotherapy (RT) alone yields similar outcomes as concurrent chemoradiotherapy, regardless of histological subtype, but chemoradiotherapy came with more grade 3 or higher hematological toxicities, new research showed.

METHODOLOGY:

• The optimal postoperative treatment regimen for patients with early-stage cervical cancer without high-risk factors remains unclear, particularly whether postoperative chemoradiotherapy is superior to RT alone.
• To investigate, researchers reviewed the medical records of 403 women with stages I-IIA cervical cancer who underwent radical surgery; 105 received postoperative RT alone; and 298 received chemoradiotherapy, with a mean follow-up of 52 months.
• The researchers excluded patients with high-risk factors, including positive pelvic lymph node(s), positive resection margin(s), and parametrial invasion.
• The authors stratified patients into intermediate-risk (350 patients) and low-risk (53 patients) groups, with large tumors (≥ 4 cm), deep stromal invasion (≥ 1/2), and lymphovascular space involvement defining the intermediate-risk group.

TAKEAWAY:

• Among intermediate-risk patients, 5-year overall survival was similar with RT alone and chemoradiotherapy (93.4% and 93.8%, respectively; P = .741); the same was true for 5-year disease-free survival (DFS, 90.6% and 91.4%, respectively; P = .733).
• Among low-risk patients, the 5-year overall survival was higher among those who received RT but not significantly so — 100.0% with RT alone vs 93.5% with chemoradiotherapy (P = .241); the 5-year DFS was similar between the two groups — 94.4% with RT and 93.5% with chemoradiotherapy (P = .736).
• Treatment outcomes remained similar regardless of histological subtype (such as squamous cell carcinoma or adenocarcinoma and adenosquamous carcinoma).
• Patients who underwent chemoradiotherapy (weekly cisplatin, most commonly) developed a higher proportion of grade ≥ 3 acute hematological toxicities than peers who had RT (44.0% vs 11.4%; P < .001), with no significant between-group difference in grade ≥ 3 chronic gastrointestinal and urogenital toxicities.

IN PRACTICE:

"For patients with early-stage cervical cancer without any high-risk factors, there was no significant difference in 5-year [overall survival] or DFS rates between postoperative adjuvant [chemoradiotherapy] and RT," but "patients who underwent postoperative [chemoradiotherapy] were more likely to develop grade ≥ 3 acute hematological toxicities," the authors concluded.

SOURCE:

The study, with co-first authors Yuncan Zhou and Weiping Wang from Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China, was published online on April 30 in BMC Cancer.

LIMITATIONS:

The study was retrospective, and some patients underwent neoadjuvant chemotherapy, which may have introduced heterogeneity to the treatment outcomes.

DISCLOSURES:

The study was supported by the National Key R&D Program of China, Ministry of Science and Technology of the People's Republic of China, and National High-Level Hospital Clinical Research Funding. The authors declared no competing interests.