Impact of Adjuvant Radiotherapy on Survival Outcomes in Intermediate-Risk, Early-Stage Cervical Cancer: Analyses Regarding Surgical Approach of Radical Hysterectomy

Se Ik Kim, Tae Hun Kim, Maria Lee, Hee Seung Kim, Hyun Hoon Chung, Taek Sang Lee, Hye Won Jeon, Jae-Weon Kim, Noh Hyun Park, Yong Sang Song, Se Ik Kim, Tae Hun Kim, Maria Lee, Hee Seung Kim, Hyun Hoon Chung, Taek Sang Lee, Hye Won Jeon, Jae-Weon Kim, Noh Hyun Park, Yong Sang Song

Abstract

This study aimed to investigate the impact of adjuvant radiotherapy (RT) on survival outcomes in patients with intermediate-risk, early-stage cervical cancer who underwent radical hysterectomy (RH). From the cervical cancer cohorts of two tertiary hospitals, patients with 2009 FIGO stage IB-IIA who underwent primary RH between 2010 and 2018 were identified. Patients with intermediate-risk factors that met the Sedlis criteria were included. Survival outcomes were compared between the patients who received adjuvant RT (study group; n = 53) and those who did not receive adjuvant treatment (control group; n = 30). Compared to the control group, the study group showed significantly better recurrence-free survival (RFS; 5-year survival rate, 85.6% vs. 61.0%; p = 0.009). In multivariate analysis, adjuvant RT was associated with a significantly lower risk of disease recurrence (adjusted HR, 0.241; 95% CI, 0.082-0.709; p = 0.010). In a subgroup that underwent open RH (n = 33), adjuvant RT showed a trend toward improved RFS with borderline statistical significance (adjusted HR, 0.098; 95% CI, 0.009-1.027; p = 0.053). However, in a subgroup of minimally invasive surgery (n = 50), adjuvant RT did not improve RFS. In conclusion, implementation of adjuvant RT significantly reduced the disease recurrence rate in patients with intermediate-risk, stage IB-IIA cervical cancer treated primarily with surgery. Survival benefit from adjuvant RT differed according to the surgical approach.

Keywords: adjuvant treatment; cervical cancer; minimally invasive surgery; radical hysterectomy; radiotherapy; recurrence.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flow diagrams depicting selection of the study population.
Figure 2
Figure 2
Comparisons of survival outcomes between the study and control groups. (A) Overall survival; (B) Recurrence-free survival.
Figure 3
Figure 3
Survival outcomes according to surgical approach of radical hysterectomy. (Upper) Open surgery; (Lower) Minimally invasive surgery. (A,C) Overall survival; (B,D) Recurrence-free survival.

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Source: PubMed

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