The outcomes and quality of life of young patients undergoing adjuvant radiotherapy versus non-radiotherapy following surgery treating early FIGO stage cervical squamous cell cancer in southwestern China

Abstract

Background: The incidence of cervical cancer in young women is rising, and squamous cell carcinoma makes up a great percentage of the histological types. the presence of aggressive pathologic risk factors following patients' primary surgery may warrant the use of adjuvant radiotherapy. it is important to weigh up the risks and benefits of using adjuvant radiotherapy for each young patient so as to maximize their prognosis while minimizing the treatment-related morbidity. Methods: A retrospective study was performed. It consisted of 97 patients under 35 years old who were diagnosed with cervical squamous cell carcinoma and underwent treatment at West china Second University Hospital between December 2009 and January 2014. Five-year follow-up, prognostic risks, long-term radiation toxicity, female sexual function, and quality of life were investigated. Results: Adjuvant radiotherapy did improve the prognosis of young patients with lymph node metastases. However, there were few significant differences in progress-free survival and overall survival for the young patients without lymph node metastases following adjuvant radiotherapy. Besides, young patients who took radiotherapy exhibited greater intestinal dysfunction, more severe lower extremities edema, greater sexual dysfunction, and worse long-term quality of life. conclusion: Young patients with early-stage cervical squamous cell carcinoma without lymph node metastases who have undergone the primary surgery should be counseled in detail before the decision to use adjuvant radiotherapy can be made. the counseling should emphasize not only the benefit that local recurrence rates can be reduced, but also the risks that treatment-related side effects could increase and lower QoL could occur. Thanks to widespread screening and advanced medical treatment, the incidence and the mortality of cervical cancer have been reduced in developed countries 1. However, in the rural developing regions of China, the morbidity of cervical cancer is still high due to the suboptimal medical conditions, making the cervical cancer a major health problem for women 2,3. Recent studies showed that the incidence of cervical cancer in young women is rising and squamous cell carcinoma (SCC) still makes up a great percentage of the histological types 4,5. To our best knowledge, the persistent infection of high-risk human papillomavirus (HPV) is identified as the most critical factor for the development of cervical cancer 6,7. For young women, the squamous-columnar junction of cervix is more vulnerable to HPV infection if she has an early age of active intercourse.

Treatment outcomes and complications in FIGO stage IIIC and IVB endometrioid endometrial cancer patients presenting as nodal spreads following systematic lymphadenectomy and adjuvant therapy

“…With regards to treatment-related toxicities, the patients who underwent lymphadenectomy combined with radiation therapy had higher complication rates including leg lymphedema and small bowel obstruction. 25,26 Similarly, the rates of grade 3 or higher toxicities were similar between the chemoradiation and chemotherapy groups in the NRG/GOG 258 trial, while the quality of life was slightly inferior in the chemoradiation group. 23 In the PORTEC-3 trial, grade 3 or higher adverse events were more frequent with chemoradiation (61% vs 13%), compared to radiation therapy alone.…”

Lower-Limb Lymphedema after Sentinel Lymph Node Biopsy in Cervical Cancer Patients

“…Such great variation is likely attributed to the flaws in LLL assessment, such as the absence of objective assessment methods, the simple postoperative assessment instead of longitudinal repeated follow-up, as well as a short period between the surgery and endpoint assessment. Moreover, out of more than 30 studies published since 2010 that report LLL incidence in cervical cancer survivors, the majority are based on retrospective cohorts in which the methodology of LLL evaluation is described vaguely or is completely missing [ 8 , 26 , 31 , 38 , 39 , 40 , 41 , 42 ].…”

Qualidade de Vida Associada ao Tratamento com Radioterapia em Mulheres Acometidas pelo Câncer do Colo do Útero: Revisão Integrativa da Literatura

“…Nesse trabalho, os piores resultados físicos, funcionais e sociais foram correlacionados com a radioterapia. Além disso, foi mostrado, ainda, que as dificuldades financeiras, pelos gastos com a radioterapia e outros fatores, influenciaram significativamente a QV das mulheres submetidas à radioterapia adjuvante, isto ocorreu também em outros estudos 15,17,18 . Portanto, pacientes jovens que fizeram radioterapia adjuvante tiveram pior QV global em longo prazo após cinco anos.…”

“…Esses dados corroboram o estudo de Yavas et al 29 , que mostrou redução dos níveis de ansiedade e depressão das pacientes ao longo do tempo. Esses autores 17 , no entanto, verificaram que as funções físicas e emocionais de mulheres submetidas à radioterapia adjuvante não melhoraram com o passar do tempo.…”