Serum squamous cell carcinoma antigen and CYFRA 21-1 in cervical cancer treatment.
OBJECTIVE
To analyze whether serum squamous cell carcinoma (SCC) antigen and cytokeratin-19 fragments (CYFRA) levels can assist in selecting patients with locally advanced cervical cancer who will benefit from combined treatment or additive surgery.


METHODS
Of 114 patients with cervical cancer Stage IB-IV, the first 39 patients received radiotherapy, the following 75 patients received identical radiotherapy plus concomitant chemotherapy (3 cycles of carboplatin and 5-fluorouracil). SCC antigen and CYFRA 21-1 serum levels were measured before treatment, after therapy, and during follow-up. Baseline tumor markers were related to tumor stage and size and clinical outcome.


RESULTS
Before treatment, SCC antigen was elevated (>1.9 microg/L) in 60% and CYFRA 21-1 (>2.2 microg/L) in 46% of patients. For all patients, disease-free survival (DFS) was better after combined treatment (67% vs. 43%, p < 0.0005). For patients with elevated baseline SCC antigen, DFS was better after combination therapy (67% vs. 27%, p = 0.001) which resulted more frequently in a normal SCC antigen (93% vs. 65%, p = 0.004). In contrast, in those with a normal baseline CYFRA 21-1, combined therapy resulted in a better DFS (p = 0.04). Patients who achieved a normal SCC antigen or CYFRA 21-1 after treatment had a better DFS (respectively 63 vs. 17% and 64 vs. 30%). Elevated SCC antigen posttreatment indicated residual tumor in 11/12 patients (92%), elevated CYFRA 21-1 in 7/10 patients (70%). Forty-seven patients had a tumor recurrence. At recurrence, SCC antigen was raised in 70% and CYFRA 21-1 in 69%.


CONCLUSIONS
In patients with an elevated pretreatment SCC antigen, SCC antigen normalized more frequently with combined treatment and those patients had a better DFS. Elevated SCC antigen or CYFRA 21-1 levels after treatment completion indicated residual tumor in respectively 92% and 70%. The presence of elevated posttreatment levels of SCC antigen or CYFRA 21-1 indicates the need for additional salvage surgery. SCC antigen proved to be superior to CYFRA 21-1 in predicting DFS and disease recurrence.
Pras
Elisabeth
E
Department of Radiation Oncology, University Hospital Groningen, Groningen, The Netherlands. E.Pras@RT.AZG.NL
Willemse
Pax H B
PH
Canrinus
Alof A
AA
de Bruijn
Henk W A
HW
Sluiter
Wim J
WJ
ten Hoor
Klaske A
KA
Aalders
Jan G
JG
Szabo
Ben G
BG
de Vries
Elisabeth G E
EG
D000328:Adult; D000368:Aged; D000951:Antigens, Neoplasm / Q000097:blood*; D014408:Biomarkers, Tumor / Q000097:blood*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D053539:Keratin-19; D007633:Keratins; D008875:Middle Aged; D009367:Neoplasm Staging; D015843:Serpins; D002583:Uterine Cervical Neoplasms / Q000097:blood* / Q000188:drug therapy / Q000532:radiotherapy
D000951:Antigens, Neoplasm; D014408:Biomarkers, Tumor; D053539:Keratin-19; D015843:Serpins; C102012:antigen CYFRA21.1; C051072:squamous cell carcinoma-related antigen; D007633:Keratins