Adjuvant pelvic radiation versus observation in intermediate-risk early-stage cervical cancer patients following primary radical surgery: a propensity score-adjusted analysis

Abstract

Objective To compare survival outcomes, posttreatment complications, and quality of life (QoL) of early-stage cervical cancer patients with intermediate-risk factors between those who received adjuvant pelvic radiation and those without adjuvant treatment. Methods Stages IB–IIA cervical cancer patients classified as having intermediate-risk following primary radical surgery were included. After propensity score weighted adjustment, all baseline demographic and pathological characteristics of 108 women who received adjuvant radiation and 111 women who had no adjuvant treatment were compared. The primary outcomes were progression-free survival (PFS) and overall survival (OS). The secondary outcomes included treatment-related complications and QoL. Results Median follow-up time was 76.1 months in the adjuvant radiation group and 95.4 months in the observation group. The 5-year PFS (91.6% in the adjuvant radiation group and 88.4% in the observation group, p=0.42) and OS (90.1% in the adjuvant radiation group and 93.5% in the observation group, p=0.36) were not significantly different between the groups. There was no significant association between adjuvant treatment and overall recurrence/death in the Cox proportional hazard model. However, a substantial reduction in pelvic recurrence was observed in participants with adjuvant radiation (hazard ratio=0.15; 95% confidence interval=0.03–0.71). Grade 3/4 treatment-related morbidities and QoL scores were not significantly different between the groups. Conclusion Adjuvant radiation was associated with a lower risk of pelvic recurrence. However, its significant benefit in reducing overall recurrence and improving survival in early-stage cervical cancer patients with intermediate-risk factors could not be demonstrated.

Role of Adjuvant Radiotherapy in Patients with Cervical Cancer Undergoing Radical Hysterectomy

“…Different statistical methods were employed in various retrospective studies to homogenise the groups and increase the reliability of the findings, which led to similar conclusions: in the multicentric study performed by Ye et al [8] that included patients with only one IRF and compared adjuvant RT, adjuvant CT and no adjuvant treatment, no significant differences were found in the 5-year OS (p = 0.486) and DFS (p = 0.874) rates between the RT group and the no further treatment group after propensity score matching; similar results were recently found by Tuscharoenporn et al [21] in their propensity score-adjusted analysis of 219 patients with stages IB-IIA and IRF according to the criteria of the Sedlis trial. There was no significant association between adjuvant treatment and OS (p = 0.36) or DFS (p = 0.42), although a lower pelvic relapse rate was observed in the RT group (p = 0.02).…”

Efficacy and safety of chemotherapy as monotherapy in patients with recurrent intermediate/high-risk factors following radical hysterectomy for stage IB-IIA cervical cancer: a single-center retrospective analysis

“…Currently, the guidelines for managing early-stage cervical cancer patients with intermediate-risk factors vary by region, and the research on postoperative adjuvant therapies is inconsistent [ 21 ]. A growing body of retrospective studies questions the role of adjuvant radiation following radical surgery for patients with intermediate-risk factors [ 22 – 26 ], shifting focus towards the potential benefits of adjuvant CT.…”