Optimal adjuvant radiotherapy strategy for cervical cancer: a multi-center database cohort study
This study aimed to explore the prognostic impact of different post-operative radiotherapy patterns in cervical cancer and identify an optimal treatment strategy using a multi-center database. This cohort was derived from the Standardized Cervical Cancer-Specific Database, and enrolled patients with clinical International Federation of Gynecology and Obstetrics stage IB1 to IIA2 undergoing radical hysterectomy and adjuvant radiation therapy, concurrent chemoradiation, or sequential chemoradiotherapy between 2019 and 2023. Patients were stratified into high-risk and intermediate-risk groups. Kaplan-Meier curves and Cox proportional hazards model regression analyses were performed to identify potential prognostic factors. Propensity score matching was subsequently applied to balance relevant covariates. A total of 1436 patients were identified (radiation therapy: 308; concurrent chemoradiation: 950; sequential chemoradiotherapy: 178) with a median follow-up of 32 months (range; 10.3-72.9). Among high-risk patients, concurrent chemoradiation showed superior 3-year progression-free survival (94.1%) versus sequential chemoradiotherapy (87.4%) or radiation therapy (83.4%, p = .014), but no significant overall survival difference was observed (concurrent chemoradiation: 88.5%; sequential chemoradiotherapy: 82.0%; radiation therapy: 77.3%, p = .07). For intermediate-risk patients, radiation therapy and concurrent chemoradiation exhibited better 3-year progression-free survival than sequential chemoradiotherapy (radiation therapy: 97.9%; concurrent chemoradiation: 96.3%; sequential chemoradiotherapy: 90.8%, p = .0019), with comparable overall survival (radiation therapy: 96.9%; concurrent chemoradiation: 95.3%; sequential chemoradiotherapy: 89.1%, p = .37). Post-matching, concurrent chemoradiation retained progression-free survival superiority in high-risk patients compared with sequential chemoradiotherapy (96.1% vs 88.9%, p = .044), whereas no progression-free survival (radiation therapy: 97.5%; concurrent chemoradiation: 94.3%, p = .22) or overall survival (radiation therapy: 96.3%; concurrent chemoradiation: 96.4%, p = .52) differences emerged between radiation therapy and concurrent chemoradiation in intermediate-risk patients. This cohort study demonstrates that concurrent chemoradiation may be considered a preferred approach for high-risk populations, whereas adding chemotherapy to radiation therapy could not improve prognosis for intermediate-risk patients.
