Статья

Comparison of outcomes between radical hysterectomy followed by tailored adjuvant therapy versus primary chemoradiation therapy in IB2 and IIA2 cervical cancer

Jeong‐Yeol ParkDepartment of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, KoreaDae‐Yeon KimDepartment of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, KoreaJong-Hyeok KimDepartment of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, KoreaYong‐Man KimDepartment of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, KoreaYoung‐Tak KimDepartment of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, KoreaYoung Seok KimDepartment of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, KoreaHa Jeong KimDepartment of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, KoreaJeong‐Won LeeDepartment of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, KoreaByoung‐Gie KimDepartment of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, KoreaDuk‐Soo BaeDepartment of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, KoreaSeung Jae HuhDepartment of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, KoreaJoo‐Hyun NamDepartment of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

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Аннотация

OBJECTIVE: To compare survival outcomes and treatment-related morbidities between radical hysterectomy (RH) and primary chemoradiation therapy (CRT) in patients with bulky early-stage cervical cancer. METHODS: We selected 215 patients with stage IB2 and IIA2 cervical cancer (tumor diameter > 4 cm on magnetic resonance imaging) who underwent RH followed by tailored adjuvant therapy (n=147) or primary CRT (n=68) at two tertiary referral centers between 2001 and 2010. RESULTS: About twenty nine percent of patients were cured by RH alone and these patients experienced the best survival outcomes with the lowest morbidity rates. After the median follow-up times of 40 months, 27 RH (18.4%) and 20 CRT (29.4%) patients had recurrence (p=0.068) and 23 (15.6%) and 17 (25%) patients died of disease (p=0.101). The 5-year progression-free survival were 77% and 66% (p=0.047), and the 5-year overall survival were 78% and 67% (p=0.048) after RH and primary CRT, respectively. In multivariate analysis, patients who received primary CRT was at higher risk for tumor recurrence (odds ratio [OR], 2.26; 95% confidence interval [CI], 1.24 to 4.14; p=0.008) and death (OR, 3.02; 95% CI, 1.53 to 5.98; p=0.001) than those who received RH. Grade 3-4, early (17% vs. 30.9%, p=0.021) and late (1.4% vs. 8.8%, p=0.007) complications were significantly less frequent after RH than primary CRT. CONCLUSION: Thirty percent of patients were cured by RH alone. A treatment outcome was better in this retrospective study in terms of morbidity and survival. Randomized trials are needed to confirm this result.

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Идентификаторы

DOI: 10.3802/jgo.2012.23.4.226

Цитирования и источники

Цитирований: 2Использованных источников: 0

Показатели — AkademScholar