Comparison of the outcome between cervical adenocarcinoma and squamous cell carcinoma patients with adjuvant radiotherapy following radical surgery: SGSG/TGCU Intergroup Surveillance

Abstract

The efficacy of radiotherapy (RT) for adenocarcinoma (AC) is controversial, although patients with AC of the uterine cervix are treated in a similar manner to those with squamous cell carcinoma (SCC). This retrospective study was conducted to evaluate the efficacy of adjuvant RT for patients with AC compared to those with SCC following radical hysterectomy. A total of 820 patients with stage IB-IIB cervical cancer, who underwent type III radical hysterectomy between 1997 and 2003, were retrospectively examined; the sample included 280 patients with AC and 540 with SCC. A total of 139 patients with AC and 327 with SCC underwent adjuvant treatment. The histological type did not affect the outcome for patients with stage I disease; however, stage II patients with AC exhibited a significantly worse 5-year overall survival (OS) rate compared to those with SCC. Patients with SCC exhibited significantly higher lymph node involvement compared to those with AC in stage IB1; however, there were no differences between stages IB2 and II. Among patients with lymph node involvement, patients with AC exhibited a significantly worse 5-year survival rate compared to those with SCC (46.4 vs. 72.3%, respectively; P=0.0005). Among patients receiving adjuvant RT, those with AC recurred more frequently compared to those with SCC, particularly in the pelvic cavity, including the vaginal stump and/or pelvis (24.6 vs. 10.5%, respectively; P= 0.0022). By contrast, the histological type did not affect the incidence of recurrence in paraaortic lymph nodes and/or distant recurrence. In conclusion, RT may not suffice as an adjuvant treatment for patients with cervical AC following radical hysterectomy.

Early-stage node negative cervical adenocarcinoma and squamous cell carcinoma show similar survival outcomes after hysterectomy: a population-based study

“…Therefore, survival may be similar in early-stage cervical SCC and AC after radical surgery. Several studies confirm our hypothesis, showing that there are no significant differences in survival between early-stage cervical SCC and AC after radical hysterectomy with lymphadenectomy [ 4 23 27 30 31 32 ]. Our findings support the hypothesis that patients with cervical AC have distinct clinical outcomes from patients with cervical SCC following the different treatment strategies.…”

“…However, the study did not perform subgroup analysis of the effect of local treatment on survival. Several studies including ours have found that in patients who received definitive radiotherapy or adjuvant radiotherapy (high-risk factors), AC subtype was associated with worse survival compared with SCC subtype, whereas histologic subtype did not affect the survival outcome of patients with low-risk group after radical hysterectomy [ 19 25 26 27 28 29 ]. Therefore, cervical AC may be resistant to radiotherapy, and surgical treatment may be the optimal treatment for early-stage cervical AC.…”

MRI texture features may predict differentiation and nodal stage of cervical cancer: a pilot study

“…Given the relatively small sample size used in this pilot study, it would be premature to draw any conclusion from this negative finding; however, it is possible that ultimately other imaging markers may be superior to texture features for prediction of the histological type (such as perfusion parameters obtained by dynamic contrast-enhanced MRI ( 7 ) or intravoxel incoherent motion imaging ( 22 )). Although the dominant factors for patient management are FIGO-stage, histological differentiation and nodal status, the histological subtype is also an independent predictor for outcome and treatment response ( 23 ). Furthermore, there was no significant correlation with the FIGO stage.…”

Biology and treatment of cervical adenocarcinoma

“…Some retrospective studies revealed poorer overall survival (OS) than that of SCC ( Table 1 ). To improve the OS in CCRT some trials that concomitant agent changed with platinum and paclitaxl,or the subsequent CT with full dose paclitaxel and carboplatin ( 1 , 2 ).…”