Efficacy of Concurrent Intensity Modulated Chemoradiotherapy Combined with Induction Chemotherapy or Adjuvant Chemotherapy in the Treatment of Locally Cervical Cancer with 2018FIGO Stage Correction.

Concurrent chemoradiotherapy (CCRT) is currently the standard treatment for locally advanced cervical cancer (LACC), but there is a lot of room for treatment strategies improvement for the survival rate of patients is low, Comprehensive treatment is the treatment direction for locally advanced cervical cancer, The current comprehensive treatment models for locally advanced cervical cancer mainly include induction chemotherapy (IC) plus concurrent chemoradiotherapy (CCRT) and CCRT plus adjuvant chemotherapy (AC),but it remains is unclear which is optimal sequence of combined chemotherapy. The purpose of this study is to retrospectively report the outcome of long-term survival and related toxicity that IC plus CCRT versus CCRT plus CCRT in LACC. From December 2016 to January 2019,358 patients with LACC who initially underwent IC plus CCRT or CCRT plus AC from the Forth Affiliated Hospital of Guangxi Medical University. All patients received cisplatin 40mg/m2, weekly one cycle concurrently with intensity-modulated radiation therapy. The IC plus CCRT group received platinum-based combined chemotherapy with two or three cycles before CCRT. CCRT plus AC group received platinum-based combined chemotherapy with two cycles after CCRT. 3-year overall survival (OS), 3-year progression free survival (PFS), local recurrence-free survival (LRFS), distant metastasis-free survival (DMFS) and treatment-related adverse reactions were evaluated and compared between the two groups. A total of 332 patients with complete follow-up data are available were included our study. Among these patients, 170 underwent the IC plus CCRT and 162 were treated with the CCRT plus AC. IC/AC regimens included TP/DP (cisplatin + Paclitaxel/Docetaxel) and TC/DC (carboplatin + Paclitaxel/Docetaxel). The median follow-up of 38 months (range = 30-50). No significant differences were detected between the two groups on the 3-year OS rates (83.5% vs. 80.2%), or LRFS rates (84.9% vs 84.8%) and DMFS rates (78.5% vs 75.5%) (all P > 0.05). Subgroup analysis revealed that CCRT plus AC was associated with significantly improved PFS (HR = 0.627, 95% CI = 0.419-0.937, P = 0.023) in 2018FIGO IIIB-IVA stage. There was no significant difference in adverse events (acute toxicities and late toxicities) between the two groups (P > 0.05). There is no statistical difference between IC plus CCRT and CCRT plus AC in the outcome of long-term survival of LACC. However, the adjuvant therapy may be more advantageous especially for the patients with 2018FIGO IIIB-IVA stage of LACC. [ABSTRACT FROM AUTHOR]

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