Is there a benefit for adjuvant radio(chemo)therapy in early cervical cancer? Results from a population-based study

Abstract

Purpose

Due to insufficient and conflicting prospective evidence, the recommendations on when to apply adjuvant radiochemotherapy in early-stage cervical cancer vary between international guidelines. In this population-based study, we evaluated the outcome of patients with early-stage cervical cancer based on risk factors and the adjuvant therapy they received.

Methods

The effect of primary therapy (surgery and radiochemotherapy RCT, surgery and radiotherapy RT, and surgery alone) on overall survival (OS) and recurrence-free survival (RFS) was evaluated in the complete cohort of 442 patients and in subgroups according to risk profile and nodal status.

Results

In low-risk patients, there was no difference in OS (p = 0.276) depending on whether patients received adjuvant therapy or not. Concerning RFS, patients with RT (including one patient with RCT) exhibited a significantly worse outcome compared to the group with surgery alone (p = 0.015). In intermediate-risk patients, the administration of adjuvant RT significantly benefited RFS when compared to surgery only in multivariate analysis (p = 0.031). Concerning OS, no significant influence for adjuvant treatment could be seen (p = 0.354). Though trends towards better OS and RFS could be observed in patients of the high-risk group—both in RCT and RT groups compared to surgery alone—the effects did not prove to be significant.

Conclusion

Our study reaffirms the evidence against the use of adjuvant radio(chemo)therapy in low-risk early-stage cervical cancer. In intermediate-, and less pronounced in high-risk patients, however, it seems to be beneficial. The role of adjuvant radio(chemo)therapy in early cervical cancer should be further investigated in prospective randomized trials.

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Availability of data and materials

The datasets generated and/or analyzed during the current study are not publicly available due to preservation of privacy but are available from the corresponding author on reasonable request.

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Authors

Contributions

Protocol/project development: MK-S, MG, SS, CB,TP. Data collection: CB, MG. Data analysis/interpretation: CB, MG, SS. Manuscript writing: SS. Manuscript editing: MK-S, AS, MA, AI, ECI,OO,OK,TP.

Corresponding author

Correspondence to Sophia Scharl.

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The authors declare that they have no conflict of interest.

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All procedures performed in this study were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments. This article does not contain any studies with human participants or animals performed by any of the authors.

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Scharl, S., Becher, C., Gerken, M. et al. Is there a benefit for adjuvant radio(chemo)therapy in early cervical cancer? Results from a population-based study. Arch Gynecol Obstet (2021). https://doi.org/10.1007/s00404-021-05989-w

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Keywords

  • Cervical cancer
  • Radio(chemo)therapy
  • Adjuvant therapy
  • Risk groups