When Does Neoadjuvant Chemotherapy Really Avoid Radiotherapy? Clinical Predictors of Adjuvant Radiotherapy in Cervical Cancer.
BACKGROUND
The aim of this study was to identify clinical variables that may predict the need for adjuvant radiotherapy after neoadjuvant chemotherapy (NACT) and radical surgery in locally advanced cervical cancer patients.


METHODS
A retrospective series of cervical cancer patients with International Federation of Gynecology and Obstetrics (FIGO) stages IB2-IIB treated with NACT followed by radical surgery was analyzed. Clinical predictors of persistence of intermediate- and/or high-risk factors at final pathological analysis were investigated. Statistical analysis was performed using univariate and multivariate analysis and using a model based on artificial intelligence known as artificial neuronal network (ANN) analysis.


RESULTS
Overall, 101 patients were available for the analyses. Fifty-two (51 %) patients were considered at high risk secondary to parametrial, resection margin and/or lymph node involvement. When disease was confined to the cervix, four (4 %) patients were considered at intermediate risk. At univariate analysis, FIGO grade 3, stage IIB disease at diagnosis and the presence of enlarged nodes before NACT predicted the presence of intermediate- and/or high-risk factors at final pathological analysis. At multivariate analysis, only FIGO grade 3 and tumor diameter maintained statistical significance. The specificity of ANN models in evaluating predictive variables was slightly superior to conventional multivariable models.


CONCLUSIONS
FIGO grade, stage, tumor diameter, and histology are associated with persistence of pathological intermediate- and/or high-risk factors after NACT and radical surgery. This information is useful in counseling patients at the time of treatment planning with regard to the probability of being subjected to pelvic radiotherapy after completion of the initially planned treatment.
Gynecologic Oncology Unit, Fondazione IRCCS National Cancer Institute, Milan, Italy.
Andrea
A
Papadia
Gynecologic Oncology Unit, Fondazione IRCCS National Cancer Institute, Milan, Italy. filippo.bellati@uniroma1.it.|Department of Gynecology Obstetrics and Urology, 'Sapienza' University of Rome, Rome, Italy. filippo.bellati@uniroma1.it.
Filippo
F
Bellati
Gynecologic Oncology Unit, Fondazione IRCCS National Cancer Institute, Milan, Italy.
Giorgio
G
Bogani
Gynecologic Oncology Unit, Fondazione IRCCS National Cancer Institute, Milan, Italy.
Antonino
A
Ditto
Gynecologic Oncology Unit, Fondazione IRCCS National Cancer Institute, Milan, Italy.
Fabio
F
Martinelli
Gynecologic Oncology Unit, Fondazione IRCCS National Cancer Institute, Milan, Italy.
Domenica
D
Lorusso
Gynecologic Oncology Unit, Fondazione IRCCS National Cancer Institute, Milan, Italy.|Department of Gynecology Obstetrics and Urology, 'Sapienza' University of Rome, Rome, Italy.
Cristina
C
Donfrancesco
Gynecologic Oncology Unit, Fondazione IRCCS National Cancer Institute, Milan, Italy.|Department of Gynecology Obstetrics and Urology, 'Sapienza' University of Rome, Rome, Italy.
Maria Luisa
ML
Gasparri
Gynecologic Oncology Unit, Fondazione IRCCS National Cancer Institute, Milan, Italy.
Francesco
F
Raspagliesi
D000230:Adenocarcinoma / Q000188:drug therapy / Q000473:pathology*; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D018196:Carcinoma, Adenosquamous / Q000188:drug therapy / Q000473:pathology*; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy / Q000473:pathology*; D017024:Chemotherapy, Adjuvant; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008198:Lymph Nodes / Q000187:drug effects / Q000473:pathology*; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control*; D009367:Neoplasm Staging; D011379:Prognosis; D018714:Radiotherapy, Adjuvant / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D015996:Survival Rate; D002583:Uterine Cervical Neoplasms / Q000188:drug therapy / Q000473:pathology*