Post-operative radiotherapy in patients with early stage cervical cancer.
OBJECTIVE
The aim of this study is to investigate the impact of treatment policy changes in cervical cancer patients treated with adjuvant (chemo) radiotherapy.


METHODS
Between 1970 and 2007, 292 patients received adjuvant radiotherapy after a radical hysterectomy with pelvic lymphadenectomy for early stage cervical carcinoma. All patients received pelvic radiotherapy (40 Gy-46 Gy in 1.8 Gy-2 Gy/fraction). Vaginal vault brachytherapy boost (10-14 Gy) was increasingly used for patients with high-risk factors, and since 1993 systematically applied in patients with at least 2 of the 3 risk factors: adenocarcinoma, nodal involvement and parametrial invasion. Cisplatin-based chemotherapy was introduced in this group of patients from 2000.


RESULTS
The 5-year cumulative risk of local recurrence (CRLR) was 13% (95%CI 9%-17%), resulting in an overall 5-year survival (OS) of 78% (95%CI 83%-73%). Since 1970, the OR for the 5-year locoregional recurrence risk (LRR) decreased from 2.5 to 1.15 (linear-OR=-0.02/year). The OR for the 5-year mortality risk reduced from 2.2 in 1970 to 1.0 in 2007 (linear-OR=-0.03/year). The largest risk reductions were observed before 1990 with a minor rise after 2002. The risk of severe late toxicity reduced from 1.8% to 1.5% (linear-OR=-0.03/year). The addition of concomitant adjuvant chemotherapy since 2000 may have benefited a subgroup of patients with squamous cell carcinoma, but not the patients with adenocarcinoma, and after introduction of chemotherapy the risk of severe late toxicity tripled from 2% to 7%.


CONCLUSIONS
Since 1970, tumour recurrence risk and mortality have decreased, as radiation dose increased. The potential benefit of concomitant adjuvant chemotherapy could not be demonstrated in this nonrandomized study.
Department of Radiotherapy, Academic Medical Center Amsterdam (AMC), The Netherlands. Electronic address: r.davilafajardo@amc.uva.nl.
Raquel
R
Dávila Fajardo
Department of Radiotherapy, Academic Medical Center Amsterdam (AMC), The Netherlands.
Rob
R
van Os
Department of Gynaecology Oncology, Academic Medical Center Amsterdam (AMC), The Netherlands.
Marrije R
MR
Buist
Department of Radiotherapy, Academic Medical Center Amsterdam (AMC), The Netherlands.
Lon
L
Uitterhoeve
Department of Medical Oncology, Academic Medical Center Amsterdam (AMC), The Netherlands.
Anneke M
AM
Westermann
Department of Gynaecology Oncology, Academic Medical Center Amsterdam (AMC), The Netherlands.
Gemma G
GG
Kenter
Department of Radiotherapy, Academic Medical Center Amsterdam (AMC), The Netherlands.
Coen R N
CR
Rasch
Department of Radiotherapy, Academic Medical Center Amsterdam (AMC), The Netherlands.
Lukas J A
LJ
Stalpers
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001918:Brachytherapy / Q000379:methods*; D059186:Chemoradiotherapy, Adjuvant; D002945:Cisplatin / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007044:Hysterectomy; D008197:Lymph Node Excision; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D009367:Neoplasm Staging; D011182:Postoperative Care; D016016:Proportional Hazards Models; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D002583:Uterine Cervical Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*
D002945:Cisplatin
Brachytherapy; Cervical cancer; Postoperative radiotherapy