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Definitive Chemoradiotherapy versus Radical Hysterectomy Followed by Tailored Adjuvant Therapy in Women with Early-Stage Cervical Cancer Presenting with Pelvic Lymph Node Metastasis on Pretreatment Evaluation: A Propensity Score Matching Analysis

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Abstract
Simple Summary Pelvic nodal involvement is frequently present in early-stage cervical cancer patients on pretreatment imaging studies. However, it is unclear whether radical chemoradiotherapy (CRT) or radical hysterectomy RH followed by tailored adjuvant radiotherapy is more appropriate in these patients. We compared oncological outcomes of up-front surgery followed by tailored adjuvant radiotherapy and definitive CRT in these patients. We found no differences in outcomes existed between definitive CRT and hysterectomy with tailored adjuvant radiotherapy. However, after surgery, 88.7% of patients required adjuvant radiotherapy. These findings suggest that definitive CRT can avoid unplanned tri-modality therapy without compromising oncologic outcomes. To compare the oncologic outcomes between chemoradiotherapy (CRT) and radical hysterectomy followed by tailored adjuvant therapy in patients with early cervical cancer presenting with pelvic lymph node metastasis. We retrospectively analyzed the medical records of women with early cervical cancer presenting with positive pelvic nodes identified on pretreatment imaging assessment. Propensity score matching was employed to control for the heterogeneity between two groups according to confounding factors. Overall survival, disease-free survival, and pattern of failure were compared between the two groups. A total of 262 patients were identified; among them, 67 received definitive CRT (group A), and 195 received hysterectomy (group B). Adjuvant therapy was administered to 88.7% of group B. There were no significant differences between group A and group B regarding the 5-year overall survival rates (89.2% vs. 89.0%) as well as disease-free survival rates (80.6% vs. 82.7%), and patterns of failure. Distant metastasis was the major failure pattern identified in both groups. In multivariate analysis, non-squamous histology was significantly associated with poorer overall survival. As there are no significant differences in 5-year OS, DFS, and patterns of failure, definitive CRT could avoid the combined modality therapy without compromising oncologic outcomes.
Author(s)
박종무김연주송미경남주현박상윤김영석김주영
Issued Date
2021
Type
Article
Keyword
chemotherapyhysterectomyradiotherapyuterine cervical cancer
DOI
10.3390/cancers13153703
URI
https://oak.ulsan.ac.kr/handle/2021.oak/7377
https://ulsan-primo.hosted.exlibrisgroup.com/primo-explore/fulldisplay?docid=TN_cdi_doaj_primary_oai_doaj_org_article_6b9e6e0b362540b6b7e9eb448ef5553a&context=PC&vid=ULSAN&lang=ko_KR&search_scope=default_scope&adaptor=primo_central_multiple_fe&tab=default_tab&query=any,contains,Definitive%20Chemoradiotherapy%20versus%20Radical%20Hysterectomy%20Followed%20by%20Tailored%20Adjuvant%20Therapy%20in%20Women%20with%20Early-Stage%20Cervical%20Cancer%20Presenting%20with%20Pelvic%20Lymph%20Node%20Metastasis%20on%20Pretreatment%20Evaluation:%20A%20Propensity%20Score%20Matching%20Analysis&offset=0&pcAvailability=true
Publisher
CANCERS
Location
스위스
Language
영어
ISSN
2072-6694
Citation Volume
13
Citation Number
15
Citation Start Page
0
Citation End Page
0
Appears in Collections:
Medicine > Medicine
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