Sophia Scharl1, Cornelia Becher2, Michael Gerken2, Anton Scharl3, Michael Anapolski4, Atanas Ignatov5, Elisabeth C Inwald5, Olaf Ortmann5, Oliver Kölbl6, Monika Klinkhammer-Schalke2, Thomas Papathemelis3. 1. Department of Radiation Oncology and Nuclear Medicine, Medizinisches Versorgungszentrum am Klinikum Rosenheim, Rosenheim, Germany. sophiascharl@yahoo.de. 2. Tumor Center, Institute for Quality Assurance and Health Services Research, University of Regensburg, Regensburg, Germany. 3. Department of Gynecology and Obstetrics, Klinikum St. Marien Amberg, Amberg, Germany. 4. Department Ob/Gyn, University of Witten-Herdecke, KKH Dormagen, Dormagen, Germany. 5. Department of Gynecology and Obstetrics, University Medical Center Regensburg, Regensburg, Germany. 6. Department of Radiation Oncology, University Medical Center Regensburg, Regensburg, Germany.
Abstract
PURPOSE: Due to insufficient and conflicting prospective evidence, the recommendations on when to apply adjuvant radiochemotherapy in early-stage cervical cancer vary between international guidelines. In this population-based study, we evaluated the outcome of patients with early-stage cervical cancer based on risk factors and the adjuvant therapy they received. METHODS: The effect of primary therapy (surgery and radiochemotherapy RCT, surgery and radiotherapy RT, and surgery alone) on overall survival (OS) and recurrence-free survival (RFS) was evaluated in the complete cohort of 442 patients and in subgroups according to risk profile and nodal status. RESULTS: In low-risk patients, there was no difference in OS (p = 0.276) depending on whether patients received adjuvant therapy or not. Concerning RFS, patients with RT (including one patient with RCT) exhibited a significantly worse outcome compared to the group with surgery alone (p = 0.015). In intermediate-risk patients, the administration of adjuvant RT significantly benefited RFS when compared to surgery only in multivariate analysis (p = 0.031). Concerning OS, no significant influence for adjuvant treatment could be seen (p = 0.354). Though trends towards better OS and RFS could be observed in patients of the high-risk group-both in RCT and RT groups compared to surgery alone-the effects did not prove to be significant. CONCLUSION: Our study reaffirms the evidence against the use of adjuvant radio(chemo)therapy in low-risk early-stage cervical cancer. In intermediate-, and less pronounced in high-risk patients, however, it seems to be beneficial. The role of adjuvant radio(chemo)therapy in early cervical cancer should be further investigated in prospective randomized trials.
PURPOSE: Due to insufficient and conflicting prospective evidence, the recommendations on when to apply adjuvant radiochemotherapy in early-stage cervical cancer vary between international guidelines. In this population-based study, we evaluated the outcome of patients with early-stage cervical cancer based on risk factors and the adjuvant therapy they received. METHODS: The effect of primary therapy (surgery and radiochemotherapy RCT, surgery and radiotherapy RT, and surgery alone) on overall survival (OS) and recurrence-free survival (RFS) was evaluated in the complete cohort of 442 patients and in subgroups according to risk profile and nodal status. RESULTS: In low-risk patients, there was no difference in OS (p = 0.276) depending on whether patients received adjuvant therapy or not. Concerning RFS, patients with RT (including one patient with RCT) exhibited a significantly worse outcome compared to the group with surgery alone (p = 0.015). In intermediate-risk patients, the administration of adjuvant RT significantly benefited RFS when compared to surgery only in multivariate analysis (p = 0.031). Concerning OS, no significant influence for adjuvant treatment could be seen (p = 0.354). Though trends towards better OS and RFS could be observed in patients of the high-risk group-both in RCT and RT groups compared to surgery alone-the effects did not prove to be significant. CONCLUSION: Our study reaffirms the evidence against the use of adjuvant radio(chemo)therapy in low-risk early-stage cervical cancer. In intermediate-, and less pronounced in high-risk patients, however, it seems to be beneficial. The role of adjuvant radio(chemo)therapy in early cervical cancer should be further investigated in prospective randomized trials.
Authors: Frederico S Falcetta; Lídia Rf Medeiros; Maria I Edelweiss; Paula R Pohlmann; Airton T Stein; Daniela D Rosa Journal: Cochrane Database Syst Rev Date: 2016-11-22
Authors: S Y Ryu; M H Kim; B H Nam; T S Lee; E S Song; C Y Park; J W Kim; Y B Kim; H S Ryu; S Y Park; K T Kim; C H Cho; C Lee; S M Kim; B G Kim; D S Bae; Y T Kim; J-H Nam Journal: Br J Cancer Date: 2013-12-19 Impact factor: 7.640