Adjuvant chemotherapy following concurrent chemoradiotherapy for uterine cervical cancer with lymphadenopathy

Abstract

Abstract. The present study aimed to retrospectively evaluate the efficacy and toxicities of adjuvant chemotherapy with paclitaxel and carboplatin (TC) following concurrent cisplatin-based chemoradiation (CCRT) in patients with cervical cancer with lymphadenopathy (N1). A total of 37 patients with FIGO stage IB2-IVA cervical carcinoma with N1 (median age 57 years, range 31-74 years) were enrolled. External beam radiation therapy was followed by high-dose-rate brachytherapy. In cases of suspected para-aortic lymphadenopathy or common iliac lymph node involvement, extended radiotherapy fields were applied. Positive lymph nodes were externally radiated. Cisplatin was administered weekly at a dose of 30 mg/m 2 during external beam radiation therapy. Adjuvant therapy was administered to 17 patients and comprised carboplatin (6 mg/ ml/ min) and paclitaxel (175 mg/m 2 ) administered monthly after CCRT, and repeated every 4 weeks for 3-6 cycles. Over a median 21.5-month follow-up, no significant differences were found in the recurrence rate, progression-free survival, overall survival, or median interval to recurrence with N1 cervical cancer patients between the two groups. Patients with para-aortic lymphadenopathy who received CCRT and adjuvant chemotherapy had a more favorable overall and disease-free survival than those treated with CCRT alone. However, 16/17 patients developed grade 3-4 leukopenia and 14/17 patients developed severe hematologic toxicity during adjuvant chemotherapy. In conclusion, adjuvant chemotherapy consisting of full dose TC therapy after CCRT was not well tolerated in general and exhibited no benefit to N1 cervical cancer patients. However, it may be of therapeutic advantage over CCRT alone in cervical cancer patients with para-aortic lymphadenopathy.

Association between expression of MMP‐7 and MMP‐9 and pelvic lymph node and para‐aortic lymph node metastasis in early cervical cancer

“…Pelvic lymph node metastasis has long been established as the most important prognostic factor in cervical cancers. However, common iliac and para‐aortic lymph node metastases in cervical cancer have been reported to be associated with markedly poor survival than other pelvic lymph node metastases . The prognoses of the patients with common iliac and para‐aortic lymph node metastasis were comparable after radical hysterectomy .…”

“…However, common iliac and para-aortic lymph node metastases in cervical cancer have been reported to be associated with markedly poor survival than other pelvic lymph node metastases. 27,28 The prognoses of the patients with common iliac and para-aortic lymph node metastasis were comparable after radical hysterectomy. 29 Therefore, further analysis was performed to investigate the association between MMP-7 and MMP-9 expression and positive common iliac artery and para-aortic lymph nodes.…”

The Role of Pretreatment FDG-PET in Treating Cervical Cancer Patients With Enlarged Pelvic Lymph Node(s) Shown on MRI: A Phase 3 Randomized Trial With Long-Term Follow-Up

“…However, several issues remain unresolved; for example, the selection of diagnostic tools for pretreatment assessment, the role of prophylactic extended-field RT (1,2), and the benefit of adjuvant chemotherapy (3,4).…”

Cervical cancer with paraaortic involvement: do patients truly benefit from tailored chemoradiation therapy? A retrospective study on 8 French centers

“…Nevertheless, patients with PA metastasis 255 were excluded from the study and a specific analysis concluded 256 this treatment was not cost-effective, due to increased financial 257 burden and toxicity [26]. In a retrospective evaluation of patients 258 with PA spread, paclitaxel and carboplatin-based adjuvant 259 chemotherapy led to better outcomes than CRT alone, despite 260 increased toxicity [27]. Neoadjuvant chemotherapy has also been 261 evaluated, with high response rates [28][29][30][31][32].…”