Is primary chemoradiation a better treatment? A retrospective study of early-stage node-positive cervical cancer

Abstract

Is primary chemoradiation a better treatment? A retrospective study of early-stage node-positive cervical cancer Nan Zhang1 , Hong Zheng1, * 1Department of Gynecology, Peking University Cancer Hospital and Institute, Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education of People’s Republic of China, 100142 Beijing, China *Correspondence: zhhong306@hotmail.com (Hong Zheng) DOI:10.31083/j.ceog4806216 This is an open access article under the CC BY 4.0 license (https://creativecommons.org/licenses/by/4.0/). Submitted: 21 December 2020 Revised: 15 February 2021 Accepted: 5 March 2021 Published: 15 December 2021 Background: Cervical cancer is the second most frequently diagnosed cancer and the third leading cause of cancer death for women in developing countries. Radical hysterectomy with bilateral pelvic lymph node dissection is usually preferred for patients with stage IB1-IIA2 disease. Currently, imaging has certain limitations in the diagnosis of lymph node metastasis, and the accuracy of detection remains unsatisfactory. Indeed, only pathological examination after removal of the suspected metastatic lymph nodes during surgery can conclusively identify the presence of metastasis. Furthermore, if a lymphatic metastasis is detected, there are no clear guidelines regarding whether to complete radical surgery or to conduct a systematic lymphadenectomy followed by adjuvant concurrent chemoradiotherapy. This retrospective study aimed to compare the efficacy and safety of the two treatment modalities in this patient population. Methods: Forty-nine stage IB1-IIA2 cervical cancer patients with lymphatic metastasis confirmed by systematic pelvic and paraaortic lymph node dissection from 2007 to 2018 were reviewed. The patients were treated with either primary chemoradiation or radical hysterectomy followed by adjuvant chemoradiation after lymphadenectomy. Survival states and adverse events of the two treatments were compared. Results: The median follow-up time was 45 (range 11–119 months) months. In the non-radical surgery group, one patient (1/15, 6.7%) relapsed and died, while in the radical surgery group, seven patients (7/27, 25.9%) relapsed and five (5/27, 18.5%) died. A significant difference was found in the mean progressionfree survival (PFS) between the two groups, which was 69 (95% confidence interval 49.118–88.882) months in the non-radical surgery group and 44 (95% confidence interval 35.857–52.143) months in the radical surgery group (p<0.01). There was a significant difference in three-year PFS (86% vs. 71%, p<0.01) between the groups. Grade 3-- 4 toxicity was comparable between the two groups (26.7% vs. 25.9%, p = 0.958). Conclusion: For stage IB1-IIA2 cervical cancer patients with positive lymph nodes, primary chemoradiation after pelvic and paraaortic lymphadenectomy seems to have better survival outcomes compared with radical hysterectomy by laparoscopy plus chemoradiation. Since this is a retrospective study with limited cases, evidence from a randomized controlled study is needed to confirm the optimal treatment for early-stage node-positive cervical cancer. Keywords Cervical cancer; Lymphatic metastasis; Radical hysterectomy