[Curative effect analysis of postoperative concurrent chemoradiotherapy on early-stage cervical cancer patients with...

Objective: To compare the curative effect of postoperative concurrent chemoradiotherapy (CCRT) and radiation therapy (RT) alone on early-stage cervical cancer patients with intermediate-risk factors. Methods: Clinical data of patients with early stage (ⅠB-ⅡA) cervical cancer who underwent radical hysterectomy and pelvic lymphadenectomy in Zhejiang Cancer Hospital between January 2008 and December 2011 were retrospectively analyzed. Cervical squamous cell carcinoma patients with more than two intermediate-risk factors, including lymphatic vascular infiltration, depth of cervical stromal infiltration >1/2 cm or tumor size >4 cm, were screened. Among them, 80 patients were divided into the RT group, 137 patients were divided into the CCRT group. The survivals of these patients were analyzed. Results: At the end of the follow-up period, a total of 22 patients were dead, one patient was alive with neoplasm. There were 23 patients who occurred recurrence/ metastasis, 14 of them were in the RT group and 9 were in the CCRT group. The 5-year progression free survival (PFS) and 5-year overall survival (OS) rate of the entire cohort were 89.9% and 89.8%, respectively. The 5-year PFS rate of RT group was 82.4%, the 5-year PFS rate of CCRT group was 94.1%, and the difference between the two groups was statistically significant (P=0.013). The 5-year OS rate of RT group was 85.1%, the 5-year OS rate of CCRT group was 92.7%, and the difference between the two groups was statistically significant (P=0.049). Univariate analysis showed that therapeutic modality was associated with the 5-year DFS and OS of early-stage cervical cancer patients with intermediate-risk factors (P<0.05). The results of multivariate analysis showed that therapeutic modality was an independent prognostic factor of favorable PFS (RR=3.741, 95% CI: 1.506-9.289, P=0.004) and OS (RR=2.754, 95%CI=1.143-6.637, P=0.024). Neither of the two groups occurred severe anemia. However, the incidence of mild and moderate anemia in the CCRT group was higher than that of RT group (P<0.001). The incidence of leukocytopenia severer than grade Ⅲ in the CCRT group was significantly higher than that of RT group (P<0.001). However, the patients could recover quickly with the treatment of granulocyte colony-stimulating factor. Conclusion: Postoperative CCRT improves the survival of early stage cervical cancer patients with two or more intermediate-risk factors.