Chemoradiotherapy in combination with radical surgery is associated with better outcome in cervical cancer patients

// Dan Zheng 1, 2, * , Hua-Ping Mou 3, * , Peng Diao 4, * , Xiao-Ming Li 5 , Chuan-Li Zhang 3 , Jing Jiang 3 , Jia-Lian Chen 3 , Li-Shuai Wang 6 , Qiu Wang 6 , Guang-Yuan Zhou 6 , Jie Chen 6 , Chuan Lin 6 and Zhi-Ping Yuan 5, 6 1 Department of Head and Neck and Mammary Gland Oncology, and Medical Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, P.R. China 2 State Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy, West China Hospital, Sichuan University, The Cancer Center, Chengdu, Sichuan, 610041, P.R. China 3 Department of Gynecology, The Second People’s Hospital of Sichuan Province, Yibin City, Yibin, Sichuan, 644000, P.R. China 4 Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, 3 University of Electronic Science and Technology of China, Chengdu, Sichuan, 610041, P.R. China 5 Department of Hematology, The First Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, 646000, P.R. China 6 Department of Oncology, The Second People’s Hospital of Sichuan Province, Yibin City, Yibin, Sichuan, 644000, P.R. China * These authors contributed equally to this work Correspondence to: Zhi-Ping Yuan, email: yuanzhipingsc@hotmail.com Keywords: cervical cancer; radical surgery; concurrent chemoradiotherapy (CCRT); clinical outcome Received: August 31, 2017      Accepted: November 16, 2017      Published: December 08, 2017 ABSTRACT Objectives: To retrospectively assess the influence of radical surgery following concurrent chemoradiotherapy (CCRT) on outcomes in cervical cancer (CC) patients. Methods: Patients diagnosed with cervical squamous cell carcinoma or adenocarcinoma (FIGO stages IB2 to IIB) at the Yinbin Second People’s Hospital between September 2008 and September 2013, were included in this study. Patients were classified into 2 groups based on the treatment received: surgery group (CCRT plus radical surgery) and non-surgery groups (CCRT only). In addition to clinical information, inter-group differences with respect to local control rate (LCR), local recurrence rate (LRR), metastasis rate, overall survival (OS), progress free survival(PFS) and complications were assessed. Results: A total of 314 patients were included in the analysis. Parametrial invasion, pelvic lymph node metastasis, tumor diameter > 4 cm and presence of residual disease were risk factors for recurrence in the non-surgery group. In patients with risk factors, radical surgery significantly improved their clinical outcome. The 3-year/5-year LCR in the surgery and non-surgery groups was 88.3%/87.4% and 82.3%/77.5%, respectively ( P = 0.04). The 3-year/5-year OS rate in the two groups was 87.1%/81.7% and 72.8%/67.3%, respectively ( P = 0.001). The 3-year/5-year LRR in the two groups were 11.7%/12.6% and 17.7%/22.5%, respectively ( P = 0.04). The metastasis rates in the two groups were 19.9% and 24.8%, respectively ( P = 0.09). Conclusions: Surgery following CCRT could improve overall survival and progressfree survival. Radical surgery following CCRT appears to confer significant benefits including an increase in LCRs and decrease in LRR in CC patients with risk factors.