Clinical efficacy of concurrent chemoradiotherapy in cervical cancer patients with pelvic and/or para-aortic lymph node metastasis treated with radical surgery
Tu Yeqiang, Tang Qiu, Yan Dingding, Lyu Xiaojuan, Chen Jianhong, Wang fangfang
Institute of Cancer Research and Basic Medical Sciences of Chinese Academy of Sciences, Cancer Hospital of University of Chinese Academy of Sciences, Department of Gynecological Radiotherapy, Zhejiang Cancer Hospital, Hangzhou 310022, China
Abstract：Objective To determine whether postoperative concurrent chemoradiotherapy (CCRT) improves the survival outcomes of cervical cancer patients with pelvic and/or para-aortic lymph node metastasis after radical surgery. Methods Clinical data of 188 cervical cancer patients presenting with pelvic and/or para-aortic lymph node metastasis after radical surgery between February 2008 and November 2011 were retrospectively analyzed. The incidence of pelvic and/or para-aortic lymph node metastasis was confirmed by postoperative pathology. The clinical efficacy of CCRT was evaluated. Results Recurrence/metastasis occurred in 46 patients. In the radiotherapy alone group, 4(57.1%) patients had recurrence/metastasis in the posterior peritoneum subgroup, 5(55.6%) in the iliac subgroup and 11(28.2%) in the pelvic non-iliac subgroup, respectively. In the CCRT group, there were 5(62.5%) cases of recurrence/metastasis in the posterior peritoneum subgroup, 5(25%) in the iliac subgroup and 16(15.2%) in the pelvic non-iliac subgroup, respectively. Compared with the radiotherapy alone, CCRT could significantly improve the 5-year overall survival (OS) rate of patients with pelvic without iliac lymph node metastasis or iliac lymph node metastasis (pelvic without iliac:88.6% vs.76.9%, P=0.003;iliac:80.0% vs.44.4%, P=0.041), whereas failed to improve the 5-year OS of patients with para-aortic lymph node metastasis (50.0% vs.42.9%, P=0.973). The location of lymph node metastasis and CCRT were the independent prognostic factors for OS (para-aortic vs. pelvic without iliac:hazard ratio[HR]=4.259,95%CI=1.700-10.671, P=0.002;iliac vs. pelvic without iliac:HR=2.985,95%CI=1.290-6.907, P=0.011;concurrent chemotherapy vs. radiotherapy alone:HR=0.439,95%CI=0.218-0.885,P=0.021). Conclusions CCRT can improve the survival of patients with pelvic lymph node metastasis, but it fails to enhance the survival rate of patients with para-aortic lymph node metastasis.
Tu Yeqiang,Tang Qiu,Yan Dingding et al. Clinical efficacy of concurrent chemoradiotherapy in cervical cancer patients with pelvic and/or para-aortic lymph node metastasis treated with radical surgery[J]. Chinese Journal of Radiation Oncology, 2020, 29(6): 446-450.
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