The Efficacy Of Adjuvant Chemotherapy Alone In Stage ⅠB/ⅡA Cervical Cancer

Objective:The aim of this study was to evaluate the effectiveness of chemotherapy alone as postsurgical adjuvant therapy on survival of patients in stage IB/IIA cervical squamous cell carcinoma meeting Sedlis criteria.Methods:We retrospectively reviewed the records of 127 patients satisfying Sedlis criteria after radical surgery for stage IB/IIA cervical cancer from January 2009 to December 2013.Of these,65 patients received radiotherapy(RT)/chemoradiotherapy(CRT),62 patients received chemotherapy(CT)alone.Both the treatment modalities were compared on 5-year overall survival(OS),progression-free survival(PFS),disease-specific survival(DSS),recurrence rates and side effects.Results:1.The 127 patients ranged in age from 24 to 73 years,with an average age of 47.45 years and a median age of 47 years.Among them,77(60.6%,77/127)were aged≥45 years.Patients who survived were followed for 60-119 months,with a median follow-up of 75 months.2.There were no obvious differences between the arms in several clinical and pathologic variables including:age(P=0.618),clinical stage(P=0.382),Sedlis criteria(P=0.811),and grade(P=0.792).Only one patients(1.6%)were at stageⅠB 1,28 patients(22%)at ⅠB2,61 patients(48%)at ⅠB3,and 6 patients(4.7%)atⅡA1,31 patients(24.4%)at ⅡA2.3.The estimated 5-year OS in all the patients was 86.6%(110/127);was 85.5%(53/62)in the CT only group and was 87.7%(57/65)in the RT/CRT group,respectively(P=0.727).Estimated 5-year PFS was 83.9%in CT group and 87.7%in RT/CRT group(P=0.564).At the final follow-up date,a total of 19 patients had died,10 in the CT-only group and 9 in the RT/CRT group.Of these deceased patients,two patients survived for more than five years(one in each group).Two patients in the CT group died of cardiovascular disease(one died within five years and the other died more than five years after surgery)and one died of lung carcinoma.In the RT/CRT group,one patient committed suicide and the other died of complication of asthma.Likewise,there was no significant difference in 5-year DSS between the two arms(CT:87.1%vs.RT/CRT:90.8%;P=0.548).4.Rate and the pattern of recurrence were not different between the groups.We observed treatment failure in 8 patients(12.9%)receiving only CT and 7(10.8%)patients receiving RT/CRT(P=0.787).Acute toxicity was more frequent in the CT group,but was statistically insignificant(P>0.05).The incidences of urinary disturbance(P=0.003)and lymphedema(P=0.041)were fewer in the CT group.Conclusions:For patients in early-stage squamous cell cervical cancer who meet sedlis criteria,postoperative adjuvant CT alone can reduce treatment-related complications while achieving a similar therapeutic effect to that of RT/CRT.Therefore,Adjuvant CT alone might be a good alternative to RT/CRT in early-stage cervical cancer.