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Oncotarget. 2017 Nov 15;8(63):106866-106875. doi: 10.18632/oncotarget.22437. eCollection 2017 Dec 5.

Effectiveness of adjuvant systemic chemotherapy for intermediate-risk stage IB cervical cancer.

Author information

1
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA.
2
Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA.
3
Department of Obstetrics and Gynecology, Tottori University, Tottori, Japan.
4
Current affiliation: Department of Obstetrics and Gynecology, Tohoku University, Miyagi, Japan.
5
Department of Gynecology, Saitama Cancer Center, Saitama, Japan.
6
Department of Obstetrics and Gynecology, University of Tsukuba Faculty of Medicine, Tsukuba, Japan.
7
Department of Obstetrics and Gynecology, Faculty of Life Sciences Kumamoto University, Kumamoto, Japan.
8
Department of Gynecology, Niigata Cancer Center Hospital, Niigata, Japan.
9
Current affiliation: Department of Obstetrics and Gynecology, Niigata Minami Hospital, Niigata, Japan.
10
Department of Obstetrics and Gynecology, The Jikei University Kashiwa Hospital, Kashiwa, Japan.
11
Current affiliation: Department of Gynecology, Chiba Tokushukai Hospital, Funabashi, Japan.
12
Department of Obstetrics and Gynecology, Kyoto University, Kyoto, Japan.
13
Current affiliation: Department of Obstetrics and Gynecology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan.
14
Department of Obstetrics and Gynecology, Tokai University, Kanagawa, Japan.
15
Department of Obstetrics and Gynecology, Iwate Medical University, Iwate, Japan.

Abstract

Objective:

To examine the effectiveness of systemic chemotherapy following radical hysterectomy for women with intermediate-risk stage IB cervical cancer.

Materials and Methods:

This is a retrospective analysis of a previously organized nation-wide cohort study examining 6,003 women with stage IB-IIB cervical cancer who underwent radical hysterectomy between 2004 and 2008 in Japan. Survival of 555 women with stage IB cervical cancer in the intermediate-risk group (deep stromal invasion > 50%, large tumor size > 4 cm, and lympho-vascular space invasion [LVSI]) were examined based on adjuvant therapy patterns: chemotherapy alone (n = 223, 40.2%), concurrent chemo-radiotherapy (n = 172, 31.0%), and radiotherapy alone (n = 160, 28.8%).

Results:

The most common intermediate-risk pattern was LVSI with deep stromal invasion (n = 216, 38.5%). The most common chemotherapeutic choice was taxane/platinum (52.2%). Women with adenocarcinoma/adenosquamous histology were more likely to receive chemotherapy (P = 0.03), and intermediate-risk pattern was not associated with chemotherapy use (P = 0.11). Women who received systemic chemotherapy had disease-free survival (5-year rate, 88.1% versus 90.2%, adjusted-hazard ratio (HR) 0.98, 95% confidence interval (CI) 0.52-1.83, P = 0.94) and cause-specific survival (95.4% versus 94.8%, adjusted-HR 0.85, 95% CI 0.34-2.07, P = 0.71) similar to those who received concurrent chemo-radiotherapy on multivariable analysis. Similar results were seen among 329 women with multiple intermediate-risk factors (5-year rates for disease-free survival, chemotherapy versus concurrent chemo-radiotherapy, 87.1% versus 90.2%, P = 0.86; and cause-specific survival 94.6% versus 93.4%, P = 0.82). Cumulative local-recurrence (P = 0.77) and distant-recurrence (P = 0.94) risks were similar across the adjuvant therapy types.

Conclusions:

Our study suggests that systemic chemotherapy may be an alternative treatment choice for adjuvant therapy in intermediate-risk stage IB cervical cancer.

KEYWORDS:

adjuvant; cervical cancer; chemotherapy; intermediate risk; radical hysterectomy

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