National Harbor, MD. (FRONTLINE MEDICAL NEWS) – Patients, even those with surgically-confirmed risk factors, fared well when they received adjuvant chemotherapy without radiotherapy for early-stage cervical cancer.

In a retrospective review of 101 patients, Kwang-Beom Lee, MD, and his associates found that patients with known surgical risk factors had a posttreatment disease-free survival rate of 94.6%, a 5-year overall survival rate of 90.6%. and a disease-specific 5-year survival rate of 96.2%. These figures compare with survival rates of 79.4%, 90.6%, and 90.6%, respectively, for early-stage cervical cancer patients with lymph node metastasis.

Dr. Lee, professor of obstetrics and gynecology at Gachon University School of Medicine, Incheon, South Korea, said that about 3,600 cases of cervical cancer are diagnosed each year in Korea, and a little more than half (58%) are early-stage cancers. Most Korean patients with International Federation of Gynecology and Obstetrics (FIGO) stage IA2-IIA cancer will receive a radical hysterectomy with lymphadenectomy, he said at the annual meeting of the Society of Gynecologic Oncology.

Dr. Lee and his colleagues sought to ascertain morbidity when patients with early cervical cancer received either adjuvant radiotherapy or concurrent chemoradiotherapy (CCRT), and to explore the potential role that chemotherapy alone might play in these patients.

Accordingly, one of the primary outcomes of the study was to determine outcomes of adjuvant chemotherapy alone for patients with FIGO stage IB-IIA cervical cancer who had surgically-confirmed risk factors, and who received radical surgery.

The surgically-confirmed factors included lymphovascular space invasion, depth of penetration, and tumor size.

Currently, Dr. Lee said, evidence indicates that CCRT for patients with high risk factors improves both progression-free survival and overall survival. For patients with intermediate risk factors, radiotherapy is associated with increased progression-free survival.

The researchers examined 101 patients in this category who were treated between March of 2006 and December of 2014 at two Korean academic medical centers, excluding patients who had positive tumor margins, who received neoadjuvant chemotherapy, or who had microscopic parametrium involvement.

The mean age of the patients was 47.1 years (range, 23-73 years). Their mean body mass index was 23.1, and two thirds of patients were premenopausal. Most patients (73.3%, n = 74) had stage IB1 cancer, while 23 (22.8%) had stage IB2 cancer, and 4 (3.9%) had stage IIA cancer. Most patients (74.3%, n = 75) had squamous cell cancer.

The radical procedure performed was a type C radical hysterectomy; patients underwent pelvic lymph node dissection, with or without para-aortic node dissection. Pelvic nodes included all of the common iliac nodes, the external and internal iliac chains, and the obturator nodes. Para-aortic node dissection included dissection up to the level of the inferior mesenteric artery.

A total of 50 patients received pelvic lymph node and para-aortic lymph node dissection, with a mean 54.5 tumors retrieved per patient. A mean of 4.58 pelvic nodes were assessed as metastatic. A mean of 11.2 para-aortic nodes were retrieved, and of these, a mean 5.3 were metastatic.

All together, 76 patients had a combination of three surgically-confirmed risk factors without positive lymph nodes; the remaining 25 patients had positive lymph nodes (4 with pelvic and para-aortic involvement, the remaining with pelvic involvement alone), and were included irrespective of whether they met other risk factor criteria.

Dr. Lee said that the protocol for chemotherapy paralelled Protocol 92 from the Gynecologic Oncology Group; patients received chemotherapy if the combination of tumor diameter, depth of stromal invasion, and lymphovascular space invasion met Protocol 92 criteria for treatment, or if more than one lymph node metastasis was found.

The chemotherapy regime for intermediate-risk patients called for six cycles of either platinum alone (n = 47), or platinum with paclitaxel (n = 54). High-risk patients received six cycles of paclitaxel and platinum.

Patients were followed for a median of 65 months, and a total of 14 patients had a recurrence.

Dr. Lee reported no conflicts of interest.

On Twitter @karioakes


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