title: Clinical behaviors and outcomes for adenocarcinoma or adenosquamous carcinoma of cervix treated by radical hysterectomy and adjuvant radiotherapy or chemoradiotherapy.
abstract: OBJECTIVE
  To compare clinical behaviors and treatment outcomes between patients with squamous cell carcinoma (SCC) and adenocarcinoma/adenosquamous carcinoma (AC/ASC) of the cervix treated with radical hysterectomy (RH) and adjuvant radiotherapy (RT) or concurrent chemoradiotherapy (CCRT).
  
  
  METHODS
  A total of 318 Stage IB-IIB cervical cancer patients, 202 (63.5%) with SCC and 116 (36.5%) with AC/ASC, treated by RH and adjuvant RT/CCRT, were included. The indications for RT/CCRT were deep stromal invasion, positive resection margin, parametrial invasion, or lymph node (LN) metastasis. Postoperative CCRT was administered in 65 SCC patients (32%) and 80 AC/ASC patients (69%). Patients with presence of parametrial invasion or LN metastasis were stratified into a high-risk group, and the rest into an intermediate-risk group. The patterns of failure and factors influencing survival were evaluated.
  
  
  RESULTS
  The treatment failed in 39 SCC patients (19.3%) and 39 AC/ASC patients (33.6%). The 5-year relapse-free survival rates for SCC and AC/ASC patients were 83.4% and 66.5%, respectively (p = 0.000). Distant metastasis was the major failure pattern in both groups. After multivariate analysis, prognostic factors for local recurrence included younger age, parametrial invasion, AC/ASC histology, and positive resection margin; for distant recurrence they included parametrial invasion, LN metastasis, and AC/ASC histology. Compared with SCC patients, those with AC/ASC had higher local relapse rates for the intermediate-risk group but a higher distant metastasis rate for the high-risk group. Postoperative CCRT tended to improve survival for intermediate-risk but not for high-risk AC/ASC patients.
  
  
  CONCLUSIONS
  Adenocarcinoma/adenosquamous carcinoma is an independent prognostic factor for cervical cancer patients treated by RH and postoperative RT. Concurrent chemoradiotherapy could improve survival for intermediate-risk, but not necessarily high-risk, AC/ASC patients.
authors.affiliation: Department of Radiation Oncology, Chang Gung Memorial Hospital, Lin-Kou, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Yi-Ting
authors.initials: YT
authors.lastname: Huang
authors.forename: Chun-Chieh
authors.initials: CC
authors.lastname: Wang
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: Hung-Hsueh
authors.initials: HH
authors.lastname: Chou
authors.forename: Steve P
authors.initials: SP
authors.lastname: Lee
authors.forename: Ji-Hong
authors.initials: JH
authors.lastname: Hong
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000556:secondary / Q000628:therapy*; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D000970:Antineoplastic Agents / Q000627:therapeutic use; D018196:Carcinoma, Adenosquamous / Q000401:mortality / Q000473:pathology / Q000556:secondary / Q000628:therapy*; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000556:secondary / Q000628:therapy*; D059248:Chemoradiotherapy / Q000401:mortality; D002945:Cisplatin / Q000008:administration & dosage; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging / Q000379:methods; D018365:Neoplasm, Residual; D017239:Paclitaxel / Q000008:administration & dosage; D018714:Radiotherapy, Adjuvant / Q000379:methods / Q000401:mortality; D012189:Retrospective Studies; D012306:Risk; D016879:Salvage Therapy / Q000379:methods; D015996:Survival Rate; D017211:Treatment Failure; D002583:Uterine Cervical Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents; D017239:Paclitaxel; D002945:Cisplatin