Risk Stratification for Failure in Patients with Advanced Cervical Cancer after Concurrent Chemoradiotherapy: Another Way to Optimise Treatment Results

Liang, Ji-An; Chen, Shang-Wen; Chang, Wei-Chun; Hung, Yao-Ching; Yeh, Lian-Shung; Yang, Shih-Neng; Lin, Fang-Jen

doi:10.1016/j.clon.2008.06.007

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Volume 20, Issue 9 , Pages 683-690, November 2008

Risk Stratification for Failure in Patients with Advanced Cervical Cancer after Concurrent Chemoradiotherapy: Another Way to Optimise Treatment Results

Ji-An Liang
- Department of Radiation Therapy and Oncology, China Medical University Hospital, Taiwan
- School of Medicine, China Medical University, Taiwan
Shang-Wen Chen
- Department of Radiation Therapy and Oncology, China Medical University Hospital, Taiwan
- Department of Radiotherapy and Oncology, Taipei Medical University–Municipal Wan Fang Hospital, Taipei, Taiwan
- Author for correspondence: Shang-Wen Chen, Department of Radiotherapy and Oncology, Taipei Medical University–Municipal Wan Fang Hospital, No.111, Section 3, Hsing-Long Road, Taipei 116, Taiwan. Tel: +886-2-28217378.
Wei-Chun Chang
- School of Medicine, China Medical University, Taiwan
- Department of Obstetrics and Gynecology, China Medical University Hospital, Taiwan
Yao-Ching Hung
- School of Medicine, China Medical University, Taiwan
- Department of Obstetrics and Gynecology, China Medical University Hospital, Taiwan
Lian-Shung Yeh
- School of Medicine, China Medical University, Taiwan
- Department of Obstetrics and Gynecology, China Medical University Hospital, Taiwan
Shih-Neng Yang
- Department of Radiation Therapy and Oncology, China Medical University Hospital, Taiwan
- School of Medicine, China Medical University, Taiwan
Fang-Jen Lin
- Department of Radiation Therapy and Oncology, China Medical University Hospital, Taiwan
- School of Medicine, China Medical University, Taiwan

Received 12 April 2008; received in revised form 16 June 2008; accepted 17 June 2008.

Abstract

Aims

To identify risk factors for disease-free survival (DFS) and para-aortic lymph node (PALN) metastasis in advanced cervical cancer patients after concurrent chemoradiotherapy (CCRT) using risk stratification.

Materials and methods

In total, 148 patients with stage IB2–IVA cervical cancer without PALN metastasis treated with a full course of CCRT were included for analysis. Radiotherapy consisted of external beam irradiation followed by four courses of high-dose rate intracavitary brachytherapy using 6.0 Gy to point A. Chemotherapy consisted of weekly cisplatin at a dose of 40mg/m² for a planned six cycles. Cox's proportional hazards model was used for risk stratification for DFS and PALN relapse-free survival.

Results

Patients were divided into low- and high-risk groups. The low-risk group was composed of patients with stage IB–IIB disease without enlarged pelvic nodes, whereas the high-risk group was comprised of patients with stage IB2–IIB tumours with enlarged nodes or those with stage III–IVA disease. The 4-year DFS for the low- and high-risk groups was 83 and 52%, respectively (P=0.0001, relative risk 4.51, 95% confidence interval 1.3–10.7), whereas the 4-year PALN metastasis-free survival for the low- and high-risk groups was 92 and 61%, respectively (P=0.0003, relative risk 4.93, 95% confidence interval 1.2–12.5).

Conclusion

The risk of failure in advanced cervical cancer patients treated in the CCRT era can be predicted. For patients with high risk of PALN relapse, this study can provide patient selection criteria when considering prophylactic PALN irradiation.

Key words: Cervical cancer, concurrent chemoradiotherapy, para-aortic lymph node metastasis, predictive model, risk stratification