Sequential chemoradiotherapy vs. radiotherapy alone or concurrent chemoradiotherapy after radical resection of stage IA2-IIA1 cervical cancer: a retrospective cohort study.
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BACKGROUND: Cervical cancer is one of the most common gynecologic malignancies worldwide, and the optimal adjuvant treatment strategy remains controversial for patients with early-stage cervical cancer with intermediate-risk factors who undergo radical surgery. This study aimed to identify the risk factors affecting prognosis and to evaluate the clinical efficacy of sequential chemoradiotherapy (SCRT) as adjuvant therapy. METHODS: The data of 152 patients with stage IA2-IIA1 cervical cancer who underwent radical hysterectomy with postoperative adjuvant therapy at Changzhou Maternal and Child Health Care Hospital between January 2014 and December 2019 were retrospectively analyzed. The patients were divided into three groups according to the mode of postoperative adjuvant therapy: the concurrent chemoradiotherapy (CCRT) group (n=56), the SCRT group (n=50), and the radiotherapy (RT) alone group (n=46). Disease-free survival (DFS), overall survival (OS), and adverse reactions were compared among the three groups. Follow-up was performed every 3-6 months until December 2023 or death. Univariate and multivariate Cox regression analyses were performed to identify prognostic factors. RESULTS: The 3-year DFS rates were 67.4%, 85.7%, and 92.0% in the RT, CCRT, and SCRT groups, respectively, and the 5-year DFS rates were 43.4%, 60.7%, and 76.0%, respectively. The 3-year OS rates were 87.0%, 91.1%, and 94.0%, respectively, and the 5-year OS rates were 49.7%, 66.1%, and 84.0%, respectively. The patients receiving SCRT demonstrated significantly improved DFS (P=0.002) and OS (P=0.001) compared with those receiving RT alone, whereas no significant differences were observed between the SCRT and CCRT groups (P=0.18 and P=0.11, respectively). Tumor size was imbalanced at baseline: tumors >4 cm were present in 35/46 (76.09%), 39/56 (69.64%), and 26/50 (52.00%) patients in the RT, CCRT, and SCRT groups, respectively. Severe myelosuppression occurred in 2/46 (4.35%), 20/56 (35.71%), and 15/50 (30.00%) patients in the RT, CCRT, and SCRT groups, respectively (P<0.05 for SCRT and CCRT vs. RT), with no significant difference between the SCRT and CCRT groups (P>0.05). The multivariate analysis identified pathological type and lymph node metastasis as independent prognostic factors for DFS and OS (P<0.05). CONCLUSIONS: In this retrospective cohort, SCRT after radical hysterectomy was associated with longer DFS and OS than RT alone in patients with stage IA2-IIA1 cervical cancer, whereas no statistically significant difference was detected between SCRT and CCRT, which should not be interpreted as evidence of equivalence. SCRT was associated with a higher incidence of severe myelosuppression than RT alone; however, its toxicity profile was comparable to that of CCRT and remained clinically manageable. These findings suggest that SCRT may serve as a viable postoperative adjuvant treatment option for selected patients with early-stage cervical cancer and risk factors for recurrence, subject to confirmation in adequately powered randomized trials.