Comparison of the survival outcome of neoadjuvant therapy followed by radical surgery with that of concomitant chemoradi
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GYNECOLOGIC ONCOLOGY
Comparison of the survival outcome of neoadjuvant therapy followed by radical surgery with that of concomitant chemoradiotherapy in patients with stage IB2–IIIB cervical adenocarcinoma Tian Tian1 · Xudong Gao1 · Yunhe Ju1,2 · Xiang Ding1,2 · Yiqin Ai1,2 Received: 4 June 2020 / Accepted: 25 September 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose To compare the survival outcome of neoadjuvant therapy (NAT) (chemotherapy or chemotherapy and intracavitary brachytherapy (ICBT) followed by radical surgery and of concomitant chemotherapy and radiotherapy (CCRT) in patients with locally advanced cervical adenocarcinoma and identify predictors of cervical adenocarcinoma. Methods We retrospectively reviewed our medical records of cervical adenocarcinoma patients treated with either NAT + surgery or CCRT in our institution from January 2013 to December 2017. The patients were treated with two-dimensional radiotherapy or three-dimensional-conformal or intensity-modulated radiotherapy combined with intracavitary brachytherapy. The regimen of concomitant chemotherapy was weekly cisplatin. The neoadjuvant chemotherapy (NACT) was paclitaxel plus cisplatin. The primary end points were overall survival (OS) and progression-free survival (PFS). Results We enrolled 121 patients. There were 42 (34.7%) patients in the NAT + surgery group and 79 (65.3%) in the CCRT group. After univariate multivariate analysis, NAT was an independent predictor of OS (p = 0.008) and PFS (p = 0.006). After propensity score matching, the 5-year OS rates in the NAT + surgery and CCRT groups were 25% and 4%, respectively (p = 0.00014), and the 5-year PFS rates were 25% and 4%, respectively (p = 0.00015). Subgroup analysis showed that the 5-year OS and PFS rates in the NACT + surgery and CCRT groups were both 20% and 8%, respectively (p = 0.015). Conclusion Compared with CCRT, NAT followed by radical surgery had better OS and PFS in locally advanced cervical adenocarcinoma. In subgroup analysis, OS and PFS were longer for NACT + surgery than for CCRT. Keywords Uterine cervical neoplasms · Adenocarcinoma · Neoadjuvant therapy · Chemoradiotherapy · Survival
Introduction Cervical cancer is a major public health problem worldwide, with an estimated 570,000 cases of cervical cancer and 311,000 deaths in 2018 [1]. Adenocarcinoma of the uterine cervix is the second most common type of cervical cancer after squamous cell carcinoma (SCC) [2]. In recent years, with the popularity of early screening of cervical cancer and the application of human papillomavirus (HPV) vaccine, the * Yiqin Ai [email protected] 1
Department of Radiation Therapy, The Third Affiliated Hospital of Kunming Medical University, Kunming 650118, Yunnan, China
Department of Radiation Therapy, The Tumor Hospital of Yunnan Province, Kunming 650118, Yunnan, China
2
incidence of cervical cancer has shown an overall downward trend [3], whereas the incidence of adenocarcinoma has increased year by year [4]. The incidences of
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