Concomitant postoperative radio-chemotherapy in high risk patients with cervical cancer stage IB and IIA
I. Mihaylova, V. Parvanova, А. Chakarova, E. Petkova, D. Katzarov
The aim of the study was to compare the treatment results, prognostic factors and toxicity of radiotherapy when used alone or in combination with Cisplatin in patients withearly stage cervical cancer – clinical stage I and IIA by FIGO, who are in high risk group due to: positive (metastatic) lymph nodes (N+), positive resection line (R+) and have hydronephrosis. For a 5-year period (2007-2012) there were 252 patients with cervical cancer stage IB and IIA, who were operated by Wertheim – Meigs, 165 of them received postoperative chemotherapy (Cisplatin) and external beam radiotherapy, while the remaining 87 external beam radiotherapy only. In pelvic region the total dose was 50Gy in daily dose 2Gy in 5fractions/ week simultaneously with Cisplatin 40 mg/m2 once/ week to total dose 200 – 250 mg. Тhere is an improvement with 8% of 5-years overall survival in the radio-chemotherapy group. Study results signify statistically significant advantage in total survival rate when using combined radio-chemotherapy in patients without accompanying hydronephrosis (р=0.00001), who had negative resection line R0 (р=0,003) and were in T1 clinical stage(р=0.012). There is also a statistically significant correlation between patients with Т2 tumors with positive (metastatic) lymph nodes (N+) – 63.2% (p=0.01) and those with Т2tumors with positive resection line (R+) – 56.6% (p=0.01). There was local recurrence in 50% of patients with R+, and in
patients with hydronephrosis when N+. Patients in the group
on simultaneous radio- and chemotherapy experienced an acceptable early hematological (grade 1) and intestinal toxicity. Use of Cisplatin improves the treatment results. Localrecurrence in 50% of R+ patient, as well as in those withaccompanying hydronephrosis due to parailliac lymph nodes metastases raise the question for precise pre-treatment staging and the need of dose increase above 50 Gy, regardless the use of Cisplatin.
|Key words: CERVICAL CANCER. RADIO-CHEMOTHERAPY FACTORS OF RISK|