Effect of pelvic radiotherapy on patients with stage IB‑IIA cervical cancer after radical hysterectomy: A single‑center retrospective study

Ishizawa,Chihiro; Taguchi,Ayumi; Tanikawa,Michihiro; Honjo,Harunori; Nishijima,Akira; Eguchi,Satoko; Miyamoto,Yuichiro; Sone,Kenbun; Tsuruga,Tetsushi; Mori,Mayuyo; Osuga,Yutaka

doi:10.3892/ol.2023.13698

Effect of pelvic radiotherapy on patients with stage IB‑IIA cervical cancer after radical hysterectomy: A single‑center retrospective study

Authors:
- Chihiro Ishizawa
- Ayumi Taguchi
- Michihiro Tanikawa
- Harunori Honjo
- Akira Nishijima
- Satoko Eguchi
- Yuichiro Miyamoto
- Kenbun Sone
- Tetsushi Tsuruga
- Mayuyo Mori
- Yutaka Osuga
View Affiliations

Affiliations: Department of Obstetrics and Gynecology, The University of Tokyo Hospital, Tokyo 113‑8655, Japan
Published online on: February 2, 2023 https://doi.org/10.3892/ol.2023.13698
Article Number: 112
Copyright: © Ishizawa et al. This is an open access article distributed under the terms of Creative Commons Attribution License [CC BY_NC 4.0].

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

Abstract

The effects of post‑operative adjuvant radiotherapy (RT) on intermediate‑risk patients with cervical cancer have not been fully elucidated. Therefore, the present study aimed to investigate the impact of RT on intermediate‑risk cervical cancer. The data of 112 patients with stage IB and IIA cervical cancer treated with radical hysterectomy between January 2009 and December 2018 were retrospectively reviewed. Overall survival (OS), progression‑free survival (PFS), and the frequency of adverse events were compared between patients with and without adjuvant RT (RT⁺ and RT^‑, respectively). Subgroup analyses of PFS based on tumor size, cervical stromal invasion, lymphovascular space invasion and histology [squamous cell carcinoma (SCC) vs. non‑SCC] were performed. Among the 112 patients, 41 received adjuvant RT. Although there were no significant differences in OS or PFS between the RT+ and RT‑ groups, the frequency of adverse events was much higher in the RT⁺ group. Patients in the RT⁺ group also had more recurrent risk factors than those in the RT^‑ group. Based on the subgroup analyses, although no significant differences were observed between any of the groups, RT demonstrated a different impact on PFS between SCC and non‑SCC: No difference was observed in the SCC group, whereas patients in the RT⁺ group tended to have poorer prognoses compared to those in the RT^‑ group of the non‑SCC group. These results suggest that the impact of post‑operative RT on stage IB and IIA cervical cancer is limited and is accompanied by increased adverse events. The eligibility of patients for post‑operative RT should be carefully determined based on the therapeutic effect of RT in each subgroup.

View Figures

View References

1	Small W Jr, Bacon MA, Bajaj A, Chuang LT, Fisher BJ, Harkenrider MM, Jhingran A, Kitchener HC, Mileshkin LR, Viswanathan AN and Gaffney DK: Cervical cancer: A global health crisis. Cancer. 123:2404–2412. 2017. View Article : Google Scholar : PubMed/NCBI
2	Song S, Song C, Kim HJ, Wu HG, Kim JH, Park NH, Song YS, Kim JW, Kang SB and Ha SW: 20 year experience of postoperative radiotherapy in IB-IIA cervical cancer patients with intermediate risk factors: Impact of treatment period and concurrent chemotherapy. Gynecol Oncol. 124:63–67. 2012. View Article : Google Scholar : PubMed/NCBI
3	National Comprehensive Cancer Network, . NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines^®): Cervical Cancer. National Comprehensive Cancer Network, Inc.; 2018
4	Peters WA III, Liu PY, Barrett RJ II, Stock RJ, Monk BJ, Berek JS, Souhami L, Grigsby P, Gordon W Jr and Alberts DS: Concurrent chemotherapy and pelvic radiation therapy compared with pelvic radiation therapy alone as adjuvant therapy after radical surgery in high-risk early-stage cancer of the cervix. J Clin Oncol. 18:1606–1613. 2000. View Article : Google Scholar : PubMed/NCBI
5	Rosa DD, Medeiros LR, Edelweiss MI, Pohlmann PR and Stein AT: Adjuvant platinum-based chemotherapy for early state cervical cancer. Cochrane Database Syst Rev. 6:CD0053422012.PubMed/NCBI
6	Landoni F, Maneo A, Colombo A, Placa F, Milani R, Perego P, Favini G, Ferri L and Mangioni C: Randomised study of radical surgery versus radiotherapy for stage Ib-IIa cervical cancer. Lancet. 350:535–540. 1997. View Article : Google Scholar : PubMed/NCBI
7	Sartori E, Tisi G, Chiudinelli F, La Face B, Franzini R and Pecorelli S: Early stage cervical cancer: Adjuvant treatment in negative lymph node cases. Gynecol Oncol. 107 (1 Suppl 1):S170–S174. 2007. View Article : Google Scholar : PubMed/NCBI
8	Ryu SY, Park SI, Nam BH, Cho CK, Kim K, Kim BJ, Kim MH, Choi SC, Lee ED and Lee KH: Is adjuvant chemoradiotherapy overtreatment in cervical cancer patients with intermediate risk factors? Int J Radiat Oncol Biol Phys. 79:794–799. 2011. View Article : Google Scholar : PubMed/NCBI
9	Sedlis A, Bundy BN, Rotman MZ, Lentz SS, Muderspach LI and Zaino RJ: A randomized trial of pelvic radiation therapy versus no further therapy in selected patients with stage IB carcinoma of the cervix after radical hysterectomy and pelvic lymphadenectomy: A Gynecologic Oncology Group Study. Gynecol Oncol. 73:177–183. 1999. View Article : Google Scholar : PubMed/NCBI
10	Rogers L, Siu SS, Luesley D, Bryant A and Dickinson HO: Radiotherapy and chemoradiation after surgery for early cervical cancer. Cochrane Database Syst Rev. 5:CD0075832012.PubMed/NCBI
11	World Medical Association, . World medical association declaration of Helsinki: Ethical principles for medical research involving human subjects. JAMA. 310:2191–2194. 2013. View Article : Google Scholar : PubMed/NCBI
12	Kim HS and Song YS: International federation of gynecology and obstetrics (FIGO) staging system revised: What should be considered critically for gynecologic cancer? J Gynecol Oncol. 20:135–136. 2009. View Article : Google Scholar : PubMed/NCBI
13	U.S. Department of Health and Human Services, . Common Terminology Criteria for Adverse Events Version 5.0 (CTCAE v5.0). https://ctep.cancer.gov/protocoldevelopment/electronic_applications/docs/ctcae_v5_quick_reference_5×7.pdfNovember 27–2017
14	Ebina Y, Mikami M, Nagase S, Tabata T, Kaneuchi M, Tashiro H, Mandai M, Enomoto T, Kobayashi Y, Katabuchi H, et al: Japan society of gynecologic oncology guidelines 2017 for the treatment of uterine cervical cancer. Int J Clin Oncol. 24:1–19. 2019. View Article : Google Scholar : PubMed/NCBI
15	Gien LT, Beauchemin MC and Thomas G: Adenocarcinoma: A unique cervical cancer. Gynecol Oncol. 116:140–146. 2010. View Article : Google Scholar : PubMed/NCBI
16	Jung EJ, Byun JM, Kim YN, Lee KB, Sung MS, Kim KT and Jeong DH: Cervical adenocarcinoma has a poorer prognosis and a higher propensity for distant recurrence than squamous cell carcinoma. Int J Gynecol Cancer. 6:1228–1236. 2017. View Article : Google Scholar : PubMed/NCBI
17	Wu SY, Huang EY and Lin H: Optimal treatments for cervical adenocarcinoma. Am J Cancer Res. 9:1224–1234. 2019.PubMed/NCBI
18	Marin F, Plesca M, Bordea CI, Moga MA and Blidaru A: Types of radical hysterectomies: From Thoma Ionescu and Wertheim to present day. J Med Life. 7:172–176. 2014.PubMed/NCBI
19	Kunieda F, Kasamatsu T, Arimoto T, Onda T, Toita T, Shibata T, Fukuda H and Kamura T; Gynecologic Cancer Study Group of the Japan Clinical Oncology Group, : Non-randomized confirmatory trial of modified radical hysterectomy for patients with tumor diameter 2 cm or less FIGO Stage IB1 uterine cervical cancer: Japan Clinical Oncology Group Study (JCOG1101). Jpn J Clin Oncol. 45:123–126. 2015. View Article : Google Scholar : PubMed/NCBI
20	Konishi I: The Okabayashi radical hysterectomy: Basic principle and step-by-step procedure. Surg J (N Y). 7 (Suppl 2):S57–S69. 2021. View Article : Google Scholar : PubMed/NCBI
21	Turner JE: Basic information for radiation therapy referral. Q Bull Northwest Univ Med Sch. 35:76–86. 1961.PubMed/NCBI
22	Hu K, Wang W, Liu X, Meng Q and Zhang F: Comparison of treatment outcomes between squamous cell carcinoma and adenocarcinoma of cervix after definitive radiotherapy or concurrent chemoradiotherapy. Radiat Oncol. 13:2492018. View Article : Google Scholar : PubMed/NCBI
23	Lee YJ, Kim YT, Kim S, Lee B, Lim MC, Kim JW and Won YJ: Prognosis of cervical cancer in the era of concurrent chemoradiation from national database in Korea: A comparison between squamous cell carcinoma and adenocarcinoma. PLoS One. 10:e01448872015. View Article : Google Scholar : PubMed/NCBI
24	Galic V, Herzog TJ, Lewin SN, Neugut AI, Burke WM, Lu YS, Hershman DL and Wright JD: Prognostic significance of adenocarcinoma histology in women with cervical cancer. Gynecol Oncol. 125:287–291. 2012. View Article : Google Scholar : PubMed/NCBI
25	Shigeta S, Shimada M, Tsuji K, Nagai T, Tanase Y, Matuo K, Kamiura S, Iwata T, Yokota H and Mikami M: Risk assessment in the patients with uterine cervical cancer harboring intermediate risk factors after radical hysterectomy: A multicenter, retrospective analysis by the Japanese gynecologic oncology group. Int J Clin Oncol. 27:1507–1515. 2022. View Article : Google Scholar : PubMed/NCBI