title: Comparison of concurrent chemoradiotherapy followed by radical surgery and high-dose-rate intracavitary brachytherapy: a retrospective study of 240 patients with FIGO stage IIB cervical carcinoma.
abstract: BACKGROUND
  The aim of this study was to compare the long-term survival outcome and late toxicity in patients with FIGO (International Federation of Gynecology and Obstetrics) stage IIB cervical carcinoma after two treatment modalities, ie, concurrent chemoradiotherapy followed by radical surgery and concurrent chemoradiotherapy followed by high-dose-rate intracavitary brachytherapy.
  
  
  METHODS
  Between November 2004 and November 2011, 240 patients with FIGO stage IIB cervical carcinoma were analyzed, comprising 119 patients treated with concurrent chemoradiotherapy followed by radical surgery (group 1) and 121 patients treated with concurrent chemoradiotherapy followed by high-dose-rate intracavitary brachytherapy (group 2). Local control, overall survival, progression-free survival, and treatment-related complications were compared between the two groups.
  
  
  RESULTS
  The median follow-up duration was 36 months. Concurrent chemoradiotherapy followed by radical surgery showed a survival benefit when comparing group 1 and group 2 (3-year overall survival, 94.9% versus 84.6%, P=0.011; 3-year progression-free survival, 91.0% versus 81.8%, P=0.049, respectively). Three-year local pelvic control was 94.6% in group 1 and 93.3% in group 2 (P=0.325). Prognostic factors in group 1 were: age (≤35 years versus >35 years), 3-year progression-free survival (74.1% versus 90.9%, P=0.037); tumor diameter (≥6 cm versus <6 cm); and 3-year progression-free survival, (60.6% versus 92.9%, P=0.004). Prognostic factors in group 2 were: tumor diameter (≥4 cm versus <4 cm); 3-year overall survival (78.0% versus 94.8%, P=0.043); tumor diameter (≥6 cm versus <6 cm); 3-year progression-free survival (42.9% versus 84.2%, P=0.032); and 3-year overall survival (42.9% versus 87.1%, P=0.013). Further, 50 patients (42.02%) in group 1 and 46 patients (38.02%) in group 2 suffered from late complications. Analysis of the difference in composition of late complications showed that the rate of leg edema was higher in group 1 (35.29% versus 4.96%, P=0.000) while the rate of radiation enteritis was higher in group 2 (30.58% versus 5.04%, P=0.000).
  
  
  CONCLUSIONS
  In patients with FIGO stage IIB cervical carcinoma, concurrent chemoradiotherapy followed by radical surgery achieved higher overall survival and progression-free survival rates in comparison with radical radiotherapy associated with concurrent chemotherapy. Tumor diameter could be a common prognostic factor in these two groups of patients.
authors.affiliation: Department of Radiation Oncology, Fourth Military Medical University, Xi'an, People's Republic of China.
authors.forename: Ning
authors.initials: N
authors.lastname: Wang
authors.affiliation: Department of Radiation Oncology, Fourth Military Medical University, Xi'an, People's Republic of China.
authors.forename: Wei-Wei
authors.initials: WW
authors.lastname: Li
authors.affiliation: Department of Radiation Oncology, Fourth Military Medical University, Xi'an, People's Republic of China.
authors.forename: Jian-Ping
authors.initials: JP
authors.lastname: Li
authors.affiliation: Department of Radiation Oncology, Fourth Military Medical University, Xi'an, People's Republic of China.
authors.forename: Juan-Yue
authors.initials: JY
authors.lastname: Liu
authors.affiliation: Department of Radiation Oncology, Fourth Military Medical University, Xi'an, People's Republic of China.
authors.forename: Yong-Chun
authors.initials: YC
authors.lastname: Zhou
authors.affiliation: Department of Radiation Oncology, Fourth Military Medical University, Xi'an, People's Republic of China.
authors.forename: Ying
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Department of Radiation Oncology, Fourth Military Medical University, Xi'an, People's Republic of China.
authors.forename: Jing
authors.initials: J
authors.lastname: Hu
authors.affiliation: Department of Gynecology and Obstetrics, Fourth Military Medical University, Xi'an, People's Republic of China.
authors.forename: Yan-Hong
authors.initials: YH
authors.lastname: Huang
authors.affiliation: Department of Oncology, Xijing Hospital, Fourth Military Medical University, Xi'an, People's Republic of China.
authors.forename: Yan
authors.initials: Y
authors.lastname: Chen
authors.affiliation: Department of Radiation Oncology, Fourth Military Medical University, Xi'an, People's Republic of China.
authors.forename: Li-Chun
authors.initials: LC
authors.lastname: Wei
authors.affiliation: Department of Radiation Oncology, Fourth Military Medical University, Xi'an, People's Republic of China.
authors.forename: Mei
authors.initials: M
authors.lastname: Shi
keywords: cervical carcinoma; late toxicity; preoperative concurrent chemoradiotherapy; prognostic factors; radical radiotherapy