Σάββατο, 29 Ιουλίου 2017

ADJUVANT CHEMOTHERAPY AFTER SURGERY FOR CERVICAL CANCER

Systemic chemotherapy administered post-surgery reduced the risk for distant recurrence in women with node-positive stage IB-IIB cervical cancer, according to results from a retrospective study of Japanese women published in the International Journal of Cancer.

Systemic chemotherapy following surgery for clinical stage IB-IIB cervical cancer with pelvic and/or para-aortic lymph node metastasis was independently associated with decreased risk of distant recurrence after 5 years (19.2%) compared with chemoradiation (24.6%; adjusted hazard ratio [HR], 0.47; 95% CI 0.31-0.71, P <.001) and radiation alone (22.1%). There were 239 cases of distant recurrence with para-aortic lymph nodes (9.3%), lung (7.5%), and thoracic/cervical lymph nodes (5.5%) as the most common sites.

However, chemotherapy was associated with an increased risk for local recurrence (23.9%) compared with chemoradiation (14.3%) and radiation alone (13.3%), and did not improve survival outcomes compared with the radiation-containing regimens.

Matsuo and his colleagues enrolled 1074 women who underwent radical hysterectomy at 116 Japanese Gynecologic Oncology Group–designated institutions from 2004 to 2008. Eligible women had node-positive high-risk disease treated with adjuvant therapy after type III radical hysterectomy and pelvic lymphadenectomy. Node metastasis included pelvic and/or para-aortic lymph nodes.

Patients in the study were treated with concurrent chemoradiation (n = 502), chemotherapy (n = 319), or radiation alone (n = 253).

Women who received neoadjuvant therapy prior to hysterectomy had distant metastasis other than para-aortic lymph node and microscopic findings of malignant cells in peritoneal cytology, and who did not receive adjuvant treatment were excluded.

Researchers said that the proportion of women who received chemotherapy increased from 15.0% in 2004 to 22.9% in 2008 (P <.001). Women who received adjuvant chemotherapy tended to be younger, and have nonsquamous histology, uterine corpus involvement, and ovarian metastasis.

Researchers recorded 364 recurrences and 241 deaths due to cervical cancer in the study. Overall median follow-up in patients who did not experience recurrence or disease-specific mortality was 64.5 months.

Five-year cumulative recurrence was similar between the groups (34.1% for chemoradiation, 29.1% for radiation, and 36.6% for chemotherapy; P = .49). Likewise, the differences in cervical cancer mortality rate between the 3 groups was minor (21.8% for chemoradiation, 21.7% for radiation, and 24.7% for chemotherapy; P = .29).

Matsuo et al determined after propensity score matching that women who received chemotherapy had lower 5-year cumulative recurrence rates (34.2% vs 35.1%; P = .94) and cervical cancer mortality rates (21.9% vs 24.7%; = .48) compared with patients treated with chemoradiation.

On multivariate analysis controlling for survival factors, researchers found that recurrence rates (HR, 0.95; 95% CI 0.70-1.28; P = .72) and risk for cervical cancer mortality (HR, 0.96; 95% CI 0.67-1.38; P = .83) were similar between the chemotherapy and chemoradiation groups.

Across histology subtypes, multivariate analysis showed that chemotherapy use was independently associated with decreased risk for distant recurrence compared with radiotherapy. The 5-year cumulative distant recurrence rate was 13.2% versus 21.7% (HR, 0.35; 95% CI, 0.19-0.65; = .001) for squamous type disease and 25.8% versus 33.8% (HR, 0.54; 95% CI, 0.31-0.94; P = .028) for nonsquamous type.

In contrast, chemotherapy was associated with higher local recurrence risk compared to the radiation group in the nonsquamous group (32.7% vs 22.5%; HR, 2.21, 95% CI; 1.25-3.89; = .006). In the squamous group, this increased risk of local recurrence with chemotherapy was marginal and did not reach statistical significance (15.6% vs 11.8%; HR, 1.61; 95% CI, 0.95-2.75; P = .08).

Matsuo K, Shimada M, Aoki Y, et al. Comparison of adjuvant therapy for node-positive clinical stage IB-IIB cervical cancer: Systemic chemotherapy versus pelvic irradiation. Int J Cancer. 2017;141(5):1042-1051. doi:10.1002/ijc.30793.

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