A comparative clinical study of postoperative intensity-modulated radiotherapy combined with concurrent and sequential chemotherapy for high-risk early-stage cervical cancer

Objective To evaluate the efficacy and acute toxicities of postoperative intensity-modulated radiotherapy (IMRT) combined with concurrent (C-IMRCT) or sequential chemotherapy (S-IMRCT) in the treatment of high-risk early-stage cervical cancer. Methods A retrospective study was performed on the clinical data of 105 patients with high-risk early-stage (ⅠB1-ⅡA2) cervical cancer from 2009 to 2017. Those patients were divided into C-IMRCT group (n=73) and S-IMRCT group (n=32). The 5-year disease-free survival (DFS) and overall survival (OS) rates, recurrence rate, metastasis rate, and acute toxicities were compared between the two groups. The survival rates were calculated by the Kaplan-Meier method and analyzed by the log-rank test. Univariate prognostic analysis was performed by the log-rank test. Recurrence, metastasis, and adverse reactions were compared using continuous correction chi-square test. Results The median follow-up time was 20 and 23 months in the C-IMRCT group and the S-IMRCT group, respectively (P=0.813). There were no significant differences in the 5-year DFS and OS rates between the two groups (72.6% vs. 72.5%, P=0.918; 82.8% vs. 78.5%, P=0.504). There were no significant differences in the recurrence and metastasis rates between the two groups (P=0.598; P=1.000). The univariate prognostic analysis showed that no pathological factor affected prognosis. There were no significant differences in the incidence rates of grade 1-2 hematological toxicity, diarrhea, and urinary tract infection between the two groups (46.6% vs. 41.9%, P=0.884; P=0.854; P=0.271). Conclusions Further clinical studies are needed in terms of the survival rate in patients with high-risk early-stage cervical cancer receiving C-IMRCT. Key words: Cervical neoplasms/intensity-modulated radiotherapy; Cervical neoplasms/chemotherapy; Concurrent chemoradiotherapy; Sequence chemoradiotherapy; Prognosis