Concomitant chemoradiation followed by radical surgery for locally advanced cervical cancer patients: a randomized controlled trial_Chinese Journal of Evidence-Based Medicine

Authors：

WU Min ¹ , ZHENG Jianqing ¹ ,  HUANG Bifen ² , CHEN Mingfen ¹ , SU Jingjing ¹ , ZHOU Yunqing ³ , HUANG Shuangying ³ , CHEN Shaorong ³ , LI Luhong ³

1. Department of Radiation Oncology, the Second Affiliated Hospital of Fujian Medical University, Quanzhou, 362000, P.R.China;
2. Department of Obstetrics and Gynecology, Quanzhou Medical College People’s Hospital Affiliated, Quanzhou, 362000, P.R.China;
3. Department of Obstetrics and Gynecology, the Second Affiliated Hospital of Fujian Medical University, Quanzhou, 362000, P.R.China;

Corresponding?author：

HUANG Bifen, Email: 408933537@qq.com

Keywords：

Uterine cervical neoplasm; Chemotherapy; Radiotherapy; Surgery; Randomized controlled trial

DOI：

10.7507/1672-2531.201805087

Video：

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ObjectivesTo explore the efficacy of simultaneous chemoradiotherapy combined with surgery for locally advanced cervical patients and perform multivariable analysis.MethodsA total of 130 cases of patients with locally advanced cervical cancer who were admitted to the Second Affiliated Hospital of Fujian Medical University from June 2012 to December 2016 were randomly divided into case group and control group. The patients in the control group were treated with platinum-based radical concurrent chemoradiation. In the case group, patients received both treatment in the control group with the addition of extensive hysterectomy and pelvic lymph node dissection. The short-term efficacy and survival outcomes of the two groups were compared.ResultsThe present study was the final report of this randomized controlled trial. 68 patients were randomly enrolled into the case group and 50 patients into control group. The non-microscopic residual tumor (non-MRT) rates were 83.8% (57/68) and microscopic residual tumor (MRT) rates were 2.9% (2/68) in the experimental group. There was no significant difference between two groups (χ²=0.008, P=0.928) in 3-year progression-free survival rate (65.6%vs. 59.6%) and 4-year progression-free survival rate (52.5% vs. 56.3%). And there was no significant difference between two groups (χ²=0.361, P=0.548) in 3-year overall survival rate (80.3%vs. 74.6%) and 4-year overall survival rate (77.6% vs. 64.9%). Multivariable analysis showed that only tumor size and parametrial invasion were significant prognostic factors of PFS (P<0.05). And only parametrial invasion was a potential prognostic indicator affecting OS (P=0.078).ConclusionParametrial invasion is an important prognostic factor. Radical concurrent chemoradiotherapy combined with surgical treatment of locally advanced cervical cancer has not significantly improved progression-free survival and overall survival. The treatment regimen should be applied with caution and selectivity.

Citation： WU Min, ZHENG Jianqing, HUANG Bifen, CHEN Mingfen, SU Jingjing, ZHOU Yunqing, HUANG Shuangying, CHEN Shaorong, LI Luhong. Concomitant chemoradiation followed by radical surgery for locally advanced cervical cancer patients: a randomized controlled trial. Chinese Journal of Evidence-Based Medicine, 2018, 18(12): 1281-1286. doi: 10.7507/1672-2531.201805087 Copy

1.	Chereau E, DE LA Hosseraye C, Ballester M, et al. The role of completion surgery after concurrent radiochemotherapy in locally advanced stages IB2-IIB cervical cancer. Anticancer Res, 2013, 33(4): 1661-1666.
2.	Alhosainy AM, Hefzi N, Abdeldayem HM, et al. The impact of concurrent chemo-irradiation followed by surgery for locally advanced cervical carcinoma. Cancer Bio, 2015, 5(4): 113-123.
3.	鄭建清, 黃碧芬, 周云清, 等. 根治性同步放化療+手術治療局部晚期宮頸癌: 一項隨機對照試驗的中期結果分析. 中國循證醫學雜志, 2017, 17(1): 1-6.
4.	Eisenhauer EA, Therasse P, Bogaerts J, et al. New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer, 2009, 45(2): 228-247.
5.	Trimble E, Gius D, Harlan LC. Impact of NCI announcement upon use of chemoradiation for women with cervical cancer. J Clin Oncol, 2007, (25): 283s.
6.	Morris M, Eifel PJ, Lu J, et al. Pelvic radiation with concurrent chemotherapy compared with pelvic and para-aortic radiation for high-risk cervical cancer. N Engl J Med, 1999, 340(15): 1137-1143.
7.	Rose PG, Bundy BN, Watkins EB, et al. Concurrent cisplatin-based radiotherapy and chemotherapy for locally advanced cervical cancer. N Engl J Med, 1999, 340(15): 1144-1153.
8.	Whitney CW, Sause W, Bundy BN, et al. Randomized comparison of fluorouracil plus cisplatin versus hydroxyurea as an adjunct to radiation therapy in stage IIB-IVA carcinoma of the cervix with negative para-aortic lymph nodes: a Gynecologic Oncology Group and Southwest Oncology Group study. J Clin Oncol, 1999, 17(5): 1339-1348.
9.	黃碧芬, 鄭建清, 李文淵, 等. 熱療輔助治療宮頸癌療效和安全性的系統評價. 中國循證醫學雜志, 2015, 15(2): 201-205.
10.	Keys HM, Bundy BN, Stehman FB, et al. Cisplatin, radiation, and adjuvant hysterectomy compared with radiation and adjuvant hysterectomy for bulky stage IB cervical carcinoma. N Engl J Med, 1999, 340(15): 1154-1161.
11.	Trimble T. Global strategies for cervical cancer control in the 21st century. Gynecol Oncol, 2005, 99(3 Suppl 1): S245.
12.	楊宇星, 程曉偉, 俞小元. 宮頸癌根治性放射治療后再手術22例臨床分析. 上海醫學, 2007, 30(2): 137-138.
13.	薛惠英. 中晚期子宮頸癌根治性放療后再手術28例臨床分析. 醫學信息(手術學分冊), 2008, 21(7): 645-646.
14.	殷向平, 趙新. 中晚期子宮頸癌放療后再手術29例療效分析. 中醫臨床研究, 2011, 3(7): 32-33.
15.	李瑞蓮, 盛修貴, 董佚美. 子宮頸癌根治性放療后再手術192例療效觀察. 中國冶金工業醫學雜志, 2009, 26(5): 543-544.
16.	Ferrandina G, Margariti PA, Smaniotto D, et al. Long-term analysis of clinical outcome and complications in locally advanced cervical cancer patients administered concomitant chemoradiation followed by radical surgery. Gynecol Oncol, 2010, 119(3): 404-410.
17.	Keys HM, Bundy BN, Stehman FB, et al. Radiation therapy with and without extrafascial hysterectomy for bulky stage IB cervical carcinoma: a randomized trial of the gynecologic oncology group. Gynecol Oncol, 2003, 89(3): 343-353.
18.	Motton S, Houvenaeghel G, Delannes M, et al. Results of surgery after concurrent chemoradiotherapy in advanced cervical cancer: comparison of extended hysterectomy and extrafascial hysterectomy. Int J Gynecol Cancer, 2010, 20(2): 268-275.
19.	Leguevaque P, Motton S, Delannes M, et al. Completion surgery or not after concurrent chemoradiotherapy for locally advanced cervical cancer? Eur J Obstet Gynecol Reprod Biol, 2011, 155(2): 188-192.
20.	Landoni F, Bocciolone L, Perego P, et al. Cancer of the cervix, FIGO stages IB and IIA: patterns of local growth and paracervical extension. Int J Gynecol Cancer, 1995, 5(5): 329-334.

1. Chereau E, DE LA Hosseraye C, Ballester M, et al. The role of completion surgery after concurrent radiochemotherapy in locally advanced stages IB2-IIB cervical cancer. Anticancer Res, 2013, 33(4): 1661-1666.
2. Alhosainy AM, Hefzi N, Abdeldayem HM, et al. The impact of concurrent chemo-irradiation followed by surgery for locally advanced cervical carcinoma. Cancer Bio, 2015, 5(4): 113-123.
3. 鄭建清, 黃碧芬, 周云清, 等. 根治性同步放化療+手術治療局部晚期宮頸癌: 一項隨機對照試驗的中期結果分析. 中國循證醫學雜志, 2017, 17(1): 1-6.
4. Eisenhauer EA, Therasse P, Bogaerts J, et al. New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer, 2009, 45(2): 228-247.
5. Trimble E, Gius D, Harlan LC. Impact of NCI announcement upon use of chemoradiation for women with cervical cancer. J Clin Oncol, 2007, (25): 283s.
6. Morris M, Eifel PJ, Lu J, et al. Pelvic radiation with concurrent chemotherapy compared with pelvic and para-aortic radiation for high-risk cervical cancer. N Engl J Med, 1999, 340(15): 1137-1143.
7. Rose PG, Bundy BN, Watkins EB, et al. Concurrent cisplatin-based radiotherapy and chemotherapy for locally advanced cervical cancer. N Engl J Med, 1999, 340(15): 1144-1153.
8. Whitney CW, Sause W, Bundy BN, et al. Randomized comparison of fluorouracil plus cisplatin versus hydroxyurea as an adjunct to radiation therapy in stage IIB-IVA carcinoma of the cervix with negative para-aortic lymph nodes: a Gynecologic Oncology Group and Southwest Oncology Group study. J Clin Oncol, 1999, 17(5): 1339-1348.
9. 黃碧芬, 鄭建清, 李文淵, 等. 熱療輔助治療宮頸癌療效和安全性的系統評價. 中國循證醫學雜志, 2015, 15(2): 201-205.
10. Keys HM, Bundy BN, Stehman FB, et al. Cisplatin, radiation, and adjuvant hysterectomy compared with radiation and adjuvant hysterectomy for bulky stage IB cervical carcinoma. N Engl J Med, 1999, 340(15): 1154-1161.
11. Trimble T. Global strategies for cervical cancer control in the 21st century. Gynecol Oncol, 2005, 99(3 Suppl 1): S245.
12. 楊宇星, 程曉偉, 俞小元. 宮頸癌根治性放射治療后再手術22例臨床分析. 上海醫學, 2007, 30(2): 137-138.
13. 薛惠英. 中晚期子宮頸癌根治性放療后再手術28例臨床分析. 醫學信息(手術學分冊), 2008, 21(7): 645-646.
14. 殷向平, 趙新. 中晚期子宮頸癌放療后再手術29例療效分析. 中醫臨床研究, 2011, 3(7): 32-33.
15. 李瑞蓮, 盛修貴, 董佚美. 子宮頸癌根治性放療后再手術192例療效觀察. 中國冶金工業醫學雜志, 2009, 26(5): 543-544.
16. Ferrandina G, Margariti PA, Smaniotto D, et al. Long-term analysis of clinical outcome and complications in locally advanced cervical cancer patients administered concomitant chemoradiation followed by radical surgery. Gynecol Oncol, 2010, 119(3): 404-410.
17. Keys HM, Bundy BN, Stehman FB, et al. Radiation therapy with and without extrafascial hysterectomy for bulky stage IB cervical carcinoma: a randomized trial of the gynecologic oncology group. Gynecol Oncol, 2003, 89(3): 343-353.
18. Motton S, Houvenaeghel G, Delannes M, et al. Results of surgery after concurrent chemoradiotherapy in advanced cervical cancer: comparison of extended hysterectomy and extrafascial hysterectomy. Int J Gynecol Cancer, 2010, 20(2): 268-275.
19. Leguevaque P, Motton S, Delannes M, et al. Completion surgery or not after concurrent chemoradiotherapy for locally advanced cervical cancer? Eur J Obstet Gynecol Reprod Biol, 2011, 155(2): 188-192.
20. Landoni F, Bocciolone L, Perego P, et al. Cancer of the cervix, FIGO stages IB and IIA: patterns of local growth and paracervical extension. Int J Gynecol Cancer, 1995, 5(5): 329-334.

Chinese Journal of Evidence-Based Medicine

Concomitant chemoradiation followed by radical surgery for locally advanced cervical cancer patients: a randomized controlled trial

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