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Original Research

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Evaluation of treatment results and prognostic factors in early-stage cervical carcinoma patients treated with postoperative radiotherapy or radiochemotherapy

  • S. Demirci1,*,
  • Z. Ozsaran1
  • A. Ozsaran2
  • F. Yavas1
  • B. Demircioglu1
  • M. Hanhan3
  • Y. Dikmen2
  • A.B. Aras1

1Department of Radiation Oncology, Ege University Faculty of Medicine, Bornova, Izmir

2Department of Gynecology and Obstetrics, Division of Gynecological Oncology, Ege University Faculty of Medicine, Bornova, Izmir

3SSK (Social Security Agency) Aegean Maternity Hospital, Oncology Department, Izmir, Turkey

DOI: 10.12892/ejgo20120162 Vol.33,Issue 1,January 2012 pp.62-67

Published: 10 January 2012

*Corresponding Author(s): S. Demirci E-mail: senem.demirci@ege.edu.tr

Abstract

Purpose: To investigate the clinical features, prognostic factors, and treatment outcome in early-stage cervical carcinoma patients treated with postoperative radiotherapy (RT)/radiochemotherapy (RCT). Methods: The records of 256 Stage IB and 11 cervical cancer patients treated with postoperative RT/RCT from 1992-2007 were retrospectively reviewed. Median age of the patients was 47 (range: 25-78). Two hundred one (78.6%) patients had squamous cell carcinoma and 29(11.3%) had adenocarcinoma. One hundred and eighty-seven (73.0%) had FIGO Stage IB and 69 (27%) had Stage II disease. Concomitant cisplatin-based chemotherapy was administered to 47 (18.4%) patients. Metastatic lymph node ratio (MLNR), defined as number of metastatic lymph nodes divided by the number of dissected lymph nodes, was 0 in 142 (55.5%) patients, from 1% to 10% in 27 (10.5%) and > 10% in 31(12.1%) patients. Results: Median follow-up duration was 60.5 months (range: 6-202 months). Five-year locoregional control (LRC), disease-free survival (DFS), disease specific survival (DSS) and overall survival (OS) rates were 90.8%, 83.4%, 91.2%, and 85%, respectively. In multivariate analysis; bulky tumor (> 4 cm) was shown as an important prognostic factor for LRC, DFS and DSS. Pretreatment hemoglobin level (< 10 g/dl) was associated with lower OS rate. Endometrial involvement was associated with lower LRC and DFS. Treatment break > 14 days showed significance for DFS and DSS. MLNR was found as a valuable prognostic factor for all endpoints (LRC, DFS, DSS and OS). The rate of grade 3-4 late toxicity was 3.6% and 2%, respectively. Conclusion: Postoperative RT/RCT is an effective treatment modality for early-stage cervical cancer patients with unfavorable features and provides satisfactory local control and survival rates with low morbidity.

Keywords

Cervical cancer; Radiotherapy; Radiochemotherapy; Prognostic factors; Metastatic lymph node ratio; Side-effects

Cite and Share

S. Demirci,Z. Ozsaran,A. Ozsaran,F. Yavas,B. Demircioglu,M. Hanhan,Y. Dikmen,A.B. Aras. Evaluation of treatment results and prognostic factors in early-stage cervical carcinoma patients treated with postoperative radiotherapy or radiochemotherapy. European Journal of Gynaecological Oncology. 2012. 33(1);62-67.

References

[1] Landoni F., Maneo A., Colombo A., Plaga F., Milani R., Perego P. et al.: “Randomised study of radical surgery versus radiotherapy for Stage Ib-IIa cervical cancer”. Lancet, 1997, 350, 535.

[2] Halperin E.C., Perez C.A., Brady L.W.: “Perez and Brady’s Principles and Practice of Radiation Oncology”. 5th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2008.

[3] Rotman M., Sedlis A., Piedmonte M.R., Bundy B., Lentz S.S., Muderspach L.I., Zaino R.J.: “A phase III randomized trial of postoperative pelvic irradiation in Stage IB cervical carcinoma with poor prognostic features: follow-up of a gynecologic oncology group study”. Int. J. Radiat. Oncol. Biol. Phys., 2006, 65, 169.

[4] Curtin J.P., Hoskins W.J., Venkatraman E.S., Almadrones L., Podratz K.C., Long H. et al.: “Adjuvant chemotherapy versus chemotherapy plus pelvic irradiation for high-risk cervical cancer patients after radical hysterectomy and pelvic lymphadenectomy (RH-PLND): a randomized phase III trial”. Gynecol. Oncol., 1996, 61, 3.

[5] Grigsby P.W.: “Postoperative irradiation in cervical cancer: prognostic factors and outcome”. Radiat. Med., 2004, 22, 106.

[6] Beesley V., Janda M., Eakin E., Obermair A., Battistutta D.: “Lymphedema after gynecological cancer treatment : prevalence, correlates, and supportive care needs”. Cancer, 2007, 109, 2607.

[7] Montz F.J., Holschneider C.H., Solh S., Schuricht L.C., Monk B.J.: “Small bowel obstruction following radical hysterectomy: risk factors, incidence, and operative findings”. Gynecol. Oncol., 1994, 53, 114.

[8] Cox J.D., Stetz J., Pajak T.F.: “Toxicity criteria of the Radiation Therapy Oncology Group (RTOG) and the European Organization for Research and Treatment of Cancer (EORTC)”. Int. J. Radiat. Oncol. Biol. Phys., 1995, 31, 1341.

[9] Atahan I.L., Yildiz F., Ozyar E., Pehlivan B., Genc M., Kose M.F. et al.: “Radiotherapy in the adjuvant setting of cervical carcinoma: treatment, results, and prognostic factors”. Int. J. Gynecol. Cancer, 2007, 17, 813.

[10] Tsai C.S., Lai C.H., Wang C.C., Chang J.T., Chang T.C., Tseng C.J., Hong J.H.: “The prognostic factors for patients with early cervical cancer treated by radical hysterectomy and postoperative radiotherapy”. Gynecol. Oncol., 1999, 75, 328.

[11] Ho C.M., Chien T.Y., Huang S.H., Wu C.J., Shih B.Y., Chang S.C. et al.: “Multivariate analysis of the prognostic factors and outcomes in early cervical cancer patients undergoing radical hysterectomy”. Gynecol. Oncol., 2004, 93, 458.

[12] Lai C.H., Hong J.H., Hsueh S., Ng K.K., Chang T.C., Tseng C.J. et al.: “Preoperative prognostic variables and the impact of postoperative adjuvant therapy on the outcomes of Stage IB or II cervical carcinoma patients with or without pelvic lymph node metastases: an analysis of 891 cases”. Cancer, 1999, 85, 1537.

[13] Aoki Y., Sasaki M., Watanabe M., Sato T., Tsuneki I., Aida H., Tanaka K.: “High-risk group in node-positive patients with Stage IB, IIA, and IIB cervical carcinoma after radical hysterectomy and postoperative pelvic irradiation”. Gynecol. Oncol., 2000, 77, 305.

[14] Peters W.A. 3rd, Liu P.Y., Barrett R.J. 2nd, Stock R.J., Monk B.J., Berek J.S. et al.: “Concurrent chemotherapy and pelvic radiation therapy compared with pelvic radiation therapy alone as adjuvant therapy after radical surgery in high-risk early-stage cancer of the cervix”. J. Clin. Oncol., 2000, 18, 1606.

[15] Kodama J., Seki N., Masahiro S., Kusumoto T., Nakamura K., Hongo A., Hiramatsu Y.: “Prognostic factors in Stage IB-IIB cervical adenocarcinoma patients treated with radical hysterectomy and pelvic lymphadenectomy”. J. Surg. Oncol., 101, 413.

[16] Piura B., Rabinovich A., Friger M.: “Surgical pathologic factors in patients with early-stage cervical carcinoma treated with radical hysterectomy and pelvic lymph node dissection: association with administration of adjuvant radiotherapy and effect on survival”. Eur. J. Gynaecol. Oncol., 2006, 27, 573.

[17] Sartori E., Tisi G., Chiudinelli F., La Face B., Franzini R., Pecorelli S.: “Early stage cervical cancer: adjuvant treatment in negative lymph node cases”. Gynecol. Oncol., 2007, 107, S170.

[18] Liu M.T., Hsu J.C., Liu W.S., Wang A.Y., Huang W.T., Chang T.H., Pi C.P., Huang C.Y. et al.: “Prognostic factors affecting the outcome of early cervical cancer treated with radical hysterectomy and post-operative adjuvant therapy”. Eur. J. Cancer Care (Engl.), 2008, 17, 174.

[19] Qiu H.B., Zhang L.Y., Li Y.F., Zhou Z.W., Keshari R.P., Xu R.H.: “Ratio of metastatic to resected lymph nodes enhances to predict survival in patients with Stage III colorectal cancer”. Ann. Surg. Oncol., 2011, 18, 1568.

[20] Showalter T.N., Winter K.A., Berger A.C., Regine W.F., Abrams R.A., Safran H. et al.: “The influence of total nodes examined, number of positive nodes, and lymph node ratio on survival after surgical resection and adjuvant chemoradiation for pancreatic cancer: a secondary analysis of RTOG 9704”. Int. J. Radiat. Oncol. Biol. Phys., 2011, 81, 1328. Epub 2010 Oct. 8.

[21] Polterauer S., Hefler L., Seebacher V., Rahhal J., Tempfer C., Horvat R. et al.: “The impact of lymph node density on survival of cervical cancer patients”. Br. J. Cancer, 103, 613.

[22] Benedetti Panici P., Basile S., Angioli R.: “Pelvic and aortic lymphadenectomy in cervical cancer: the standardization of surgical procedure and its clinical impact”. Gynecol. Oncol., 2009, 113, 284.

[23] Kesic V.: “Management of cervical cancer”. Eur. J. Surg. Oncol., 2006, 32, 832.

[24] Pieterse Q.D., Kenter G.G., Gaarenstroom K.N., Peters A.A., Willems S.M., Fleuren G.J., Trimbos J.B.: “The number of pelvic lymph nodes in the quality control and prognosis of radical hysterectomy for the treatment of cervical cancer”. Eur. J. Surg. Oncol., 2007, 33, 216.

[25] Mayr N.A., Wang J.Z., Zhang D., Montebello J.F., Grecula J.C., Lo S.S. et al.: “Synergistic effects of hemoglobin and tumor perfusion on tumor control and survival in cervical cancer”. Int. J. Radiat. Oncol. Biol. Phys., 2009, 74, 1513.

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