title: Risk stratification of patients with advanced squamous cell carcinoma of cervix treated by radiotherapy alone.
abstract: OBJECTIVE
  To identify prognostic factors for local and distant relapse and perform risk stratification for patients with advanced cervical cancer treated with radiotherapy (RT) alone.
  
  
  METHODS
  A total of 1031 patients with Stage IB-IVA squamous cell carcinoma of the cervix treated with full-course RT but without any chemotherapy were included for analysis. Of these, 311 patients with nonbulky Stage IB-IIA disease were designated the reference group and the other 720 patients were the study group. The associations of stage, squamous cell carcinoma antigen (SCC-ag) level, hemoglobin level, age, cell differentiation, and pelvic lymph node status with treatment failure were evaluated. The independent prognostic factors were identified by multivariate analysis. The study group was further stratified into subgroups using combinations of these risk factors.
  
  
  RESULTS
  In the study group, independent risk factors for local relapse were advanced stage and age <45 years. The 5-year local relapse-free survival rate was 86% for patients > or =45 years with bulky Stage IB-IIA or IIB disease, and was even greater, up to 90% if the SCC-ag level was <2. In contrast, it was 65% for patients with Stage IIIB who were <45 years old. The independent risk factors for distant failure were advanced stage, SCC-ag level >2, and positive pelvic lymph nodes. The 5-year distant relapse-free survival rate was 83% for patients with bulky Stage IB-IIA and IIB disease, SCC-ag level <2, and negative lymph nodes and 43% for patients with Stage III, SCC-ag level >2, and positive lymph nodes.
  
  
  CONCLUSIONS
  The risk of treatment failure in advanced-stage cervical cancer patients treated by RT alone can be more precisely predicted by risk stratification. A certain subgroup of patients had better control than the others. The benefit of treating these relatively low-risk patients with additional treatment such as concurrent chemotherapy should be further evaluated in prospective studies or meta-analyses.
authors.affiliation: Department of Radiation Oncology, Chang Gung Memorial Hospital and University, No. 5 Fu-Shin Street, Kwei-Shan, Taoyuan, Taiwan. jihong@adm.cgmh.org.tw
authors.forename: Ji-Hong
authors.initials: JH
authors.lastname: Hong
authors.forename: Chien-Sheng
authors.initials: CS
authors.lastname: Tsai
authors.forename: Chyong-Huey
authors.initials: CH
authors.lastname: Lai
authors.forename: Ting-Chang
authors.initials: TC
authors.lastname: Chang
authors.forename: Chun-Chieh
authors.initials: CC
authors.lastname: Wang
authors.forename: Hung-Hsueh
authors.initials: HH
authors.lastname: Chou
authors.forename: Steve P
authors.initials: SP
authors.lastname: Lee
authors.forename: Chung-Chi
authors.initials: CC
authors.lastname: Lee
authors.forename: Simon G
authors.initials: SG
authors.lastname: Tang
authors.forename: Swei
authors.initials: S
authors.lastname: Hsueh
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000951:Antigens, Neoplasm / Q000097:blood; D002294:Carcinoma, Squamous Cell / Q000097:blood / Q000473:pathology / Q000532:radiotherapy*; D005260:Female; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015843:Serpins / Q000097:blood; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000532:radiotherapy*
chemical_list: D000951:Antigens, Neoplasm; D015843:Serpins; C051072:squamous cell carcinoma-related antigen