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Evaluation of treatment results and prognostic factors in early-stage cervical carcinoma patients treated with postoperative radiotherapy or radiochemotherapy
S. Demirci1,*, Z. Ozsaran1, A. Ozsaran2, F. Yavas1, B. Demircioglu1, M. Hanhan3, Y. Dikmen2, A.B. Aras1
1 Department of Radiation Oncology, Ege University Faculty of Medicine, Bornova, Izmir
2 Department of Gynecology and Obstetrics, Division of Gynecological Oncology, Ege University Faculty of Medicine, Bornova, Izmir
3 SSK (Social Security Agency) Aegean Maternity Hospital, Oncology Department, Izmir (Turkey)
Eur. J. Gynaecol. Oncol. 2012, 33(1), 62–67;
Published: 10 February 2012
Purpose: To investigate the clinical features, prognostic factors, and treatment outcome in early-stage cervical carcinoma patients treated with postoperative radiotherapy (RT)/radiochemotherapy (RCT). Methods: The records of 256 Stage IB and II cervical cancer patients treated with postoperative RT/RCT from 1992-2007 were retrospectively reviewed. Median age of the patients was 47 (range: 25-78). Two hundred one (78.6%) patients had squamous cell carcinoma and 29 (11.3%) had adenocarcinoma. One hundred and eighty-seven (73.0%) had FIGO Stage IB and 69 (27%) had Stage II disease. Concomitant cisplatin-based chemotherapy was administered to 47 (18.4%) patients. Metastatic lymph node ratio (MLNR), defined as number of metastatic lymph nodes divided by the number of dissected lymph nodes, was 0 in 142 (55.5%) patients, from 1% to 10% in 27 (10.5%) and >10% in 31 (12.1%) patients. Results: Median follow-up duration was 60.5 months (range: 6-202 months). Five-year locoregional control (LRC), diseasefree survival (DFS), disease specific survival (DSS) and overall survival (OS) rates were 90.8%, 83.4%, 91.2%, and 85%, respectively. In multivariate analysis; bulky tumor (>4 cm) was shown as an important prognostic factor for LRC, DFS and DSS. Pretreatment hemoglobin level (<10 g/dL) was associated with lower OS rate. Endometrial involvement was associated with lower LRC and DFS. Treatment break >14 days showed significance for DFS and DSS. MLNR was found as a valuable prognostic factor for all endpoints (LRC, DFS, DSS and OS). The rate of grade 3-4 late toxicity was 3.6% and 2%, respectively. Conclusion: Postoperative RT/RCT is an effective treatment modality for early-stage cervical cancer patients with unfavorable features and provides satisfactory local control and survival rates with low morbidity.
Metastatic lymph node ratio