Impact of adjuvant chemotherapy on relapse-free survival of patients with locally advanced cervical cancer

Background. In the NCCN guidelines published in 2020, chemoradiation treatment with adjuvant chemotherapy for patients with stage FIGO III cervical cancer was considered counter-productive. Long-term outcomes of treatment for patients with locally advanced disease (IIIC) are still not satisfactory. The desire to change the current situation resulted in the studying of the effectiveness of adjuvant chemotherapy in cervical cancer patients with regional lymph nodes metastases.

Objective: to evaluate the effectiveness of the combination of neoadjuvant chemoradiation plus adjuvant chemotherapy in patients with FIGO stage III cervical cancer (T1–2N1M0).

Materials and methods. The main group included 119 patients  who received chemoradiation followed by adjuvant chemotherapy with cisplatin from 2015 to 2018. The comparison group included 66 patients who received the same combination treatment between 2015 and 2018, however, without adjuvant chemotherapy. Adjuvant chemotherapy did not result in a quality of life reduction. Also, acceptable toxicity was achieved.

Results. The follow-up period for patients included in our research was 3 years or more. Recurrences occurred in 32 (27 %) patients in the main group and 31 (47 %) patients in the comparison group. During the first year of follow-up, recurrences occurred in 8 % in the main group and 43 % in a comparison group of patients respectively. There was a difference in the localization of recurrent events. Importantly, no cases of local recurrences were detected.

Conclusion. Disease recurrences more often developed in patients of reproductive age and squamous histological type of tumor. Mostly, the progression of the disease was manifested by metastases in the paraaortic lymph nodes. Almost half of all progression cases (48 %) in the comparison group appeared to be hematogenic metastasis. Most often the lungs and bones damage was detected.

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