J Gynecol Oncol.  2015 Jan;26(1):12-18. 10.3802/jgo.2015.26.1.12.

Prognostic factors for patients with cervical cancer treated with concurrent chemoradiotherapy: a retrospective analysis in a Japanese cohort

• Endo D
• Todo Y
• Okamoto K
• Minobe S
• Kato H
• Nishiyama

• KMID: 2158797
• DOI: http://doi.org/10.3802/jgo.2015.26.1.12

Abstract

OBJECTIVE
Concurrent chemoradiotherapy (CCRT) is the primary treatment for locally advanced cervical cancer. We studied prognostic factors for patients treated with CCRT.
METHODS
We retrospectively reviewed records of 85 consecutive patients with cervical cancer who were treated with CCRT between 2002 and 2011, with external beam radiation therapy, intracavitary brachytherapy, and platinum-based chemotherapy. Survival data were analyzed with Kaplan-Meier methods and Cox proportional hazard models.
RESULTS
Of the 85 patients, 69 patients (81%) had International Federation of Gynecology and Obstetrics (FIGO) stage III/IV disease; 25 patients (29%) had pelvic lymph node enlargement (based on magnetic resonance imaging), and 64 patients (75%) achieved clinical remission following treatment. Median maximum tumor diameter was 5.5 cm. The 3- and 5-year overall survival rates were 60.3% and 55.5%, respectively. Cox regression analysis showed tumor diameter >6 cm (hazard ratio [HR], 2.3; 95% confidence interval [CI], 1.2 to 4.6), pelvic lymph node enlargement (HR, 2.2; 95% CI, 1.1 to 4.5), and distant metastasis (HR, 10.0; 95% CI, 3.7 to 27.0) were significantly and independently related to poor outcomes.
CONCLUSION
New treatment strategies should be considered for locally advanced cervical cancers with tumors >6 cm and radiologically enlarged pelvic lymph nodes.

Keyword

Brachytherapy; Chemoradiotherapy; Proportional Hazards Models; Retrospective Studies; Uterine Cervical Neoplasms

MeSH Terms

Adult
Aged
Aged, 80 and over
Brachytherapy/adverse effects/methods
Chemoradiotherapy/adverse effects/*methods
Female
Humans
Kaplan-Meier Estimate
Lymphatic Metastasis
Middle Aged
Prognosis
Proportional Hazards Models
Retrospective Studies
Treatment Outcome
Uterine Cervical Neoplasms/diagnosis/pathology/*therapy

Figure

• 

  Fig. 1 (A) Univariate survival plot by Kaplan-Meier for estimation of overall survival in 85 patients with cervical cancer who were treated with concurrent chemoradiotherapy. (B) Another Kaplan-Meier analysis showed significant differences in overall survival rates among three groups (log-rank test: p=0.001): (a) a group of patients with tumor diameter <6 cm and no pelvic lymph node enlargement; (b) a group of patients with either tumor diameter ≥6 cm or pelvic lymph node enlargement; (c) a group of patients with both tumor diameter ≥6 cm and pelvic lymph node enlargement.

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