Risk stratification for failure in patients with advanced cervical cancer after concurrent chemoradiotherapy: another way to optimise treatment results.
OBJECTIVE
To identify risk factors for disease-free survival (DFS) and para-aortic lymph node (PALN) metastasis in advanced cervical cancer patients after concurrent chemoradiotherapy (CCRT) using risk stratification.


METHODS
In total, 148 patients with stage IB2-IVA cervical cancer without PALN metastasis treated with a full course of CCRT were included for analysis. Radiotherapy consisted of external beam irradiation followed by four courses of high-dose rate intracavitary brachytherapy using 6.0 Gy to point A. Chemotherapy consisted of weekly cisplatin at a dose of 40mg/m(2) for a planned six cycles. Cox's proportional hazards model was used for risk stratification for DFS and PALN relapse-free survival.


RESULTS
Patients were divided into low- and high-risk groups. The low-risk group was composed of patients with stage IB-IIB disease without enlarged pelvic nodes, whereas the high-risk group was comprised of patients with stage IB2-IIB tumours with enlarged nodes or those with stage III-IVA disease. The 4-year DFS for the low- and high-risk groups was 83 and 52%, respectively (P=0.0001, relative risk 4.51, 95% confidence interval 1.3-10.7), whereas the 4-year PALN metastasis-free survival for the low- and high-risk groups was 92 and 61%, respectively (P=0.0003, relative risk 4.93, 95% confidence interval 1.2-12.5).


CONCLUSIONS
The risk of failure in advanced cervical cancer patients treated in the CCRT era can be predicted. For patients with high risk of PALN relapse, this study can provide patient selection criteria when considering prophylactic PALN irradiation.
Liang
Ji-An
JA
Department of Radiation Therapy and Oncology, China Medical University Hospital, Taiwan.
Chen
Shang-Wen
SW
Chang
Wei-Chun
WC
Hung
Yao-Ching
YC
Yeh
Lian-Shung
LS
Yang
Shih-Neng
SN
Lin
Fang-Jen
FJ
D000230:Adenocarcinoma / Q000188:drug therapy / Q000473:pathology* / Q000532:radiotherapy*; D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001918:Brachytherapy / Q000379:methods*; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy / Q000473:pathology* / Q000532:radiotherapy*; D002945:Cisplatin / Q000627:therapeutic use; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008207:Lymphatic Metastasis; D008875:Middle Aged; D049268:Positron-Emission Tomography; D016016:Proportional Hazards Models; D012307:Risk Factors; D002583:Uterine Cervical Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000532:radiotherapy*
D000970:Antineoplastic Agents; D002945:Cisplatin