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A retrospective comparison of outcome in IB2 and IIA cervical cancer patients treated with primary concurrent chemoradiation versus radical hysterectomy with or without tailored adjuvant therapy

대한산부인과학회지 2017년 60권 6호 p.549 ~ 557
 ( Jang Tae-Kyu ) - Keimyung University School of Medicine Department of Obstetrics and Gynecology

 ( Shin So-Jin ) - Keimyung University School of Medicine Department of Obstetrics and Gynecology
 ( Chung Hye-won ) - Keimyung University School of Medicine Department of Obstetrics and Gynecology
 ( Kwon Sang-Hoon ) - Keimyung University School of Medicine Department of Obstetrics and Gynecology
 ( Cha Soon-Do ) - Keimyung University School of Medicine Department of Obstetrics and Gynecology
 ( Lee Eun-Bi ) - Keimyung University School of Medicine Department of Obstetrics and Gynecology
 ( Shin Chang-Min ) - Keimyung University School of Medicine Department of Obstetrics and Gynecology
 ( Cho Chi-Heum ) - Keimyung University School of Medicine Department of Obstetrics and Gynecology

Abstract


Objective: The aim of our study is to compare the overall survival (OS), progression-free survival (PFS), and treatment-related morbidities between primary concurrent chemoradiation therapy (CCRT) vs. radical hysterectomy (RH) with or without tailored adjuvant therapy in patients with stages IB2 and IIA cervical cancer.

Methods: This was a retrospective study of 113 patients with IB2 or IIA cervical cancer treated with either primary CCRT (n=49) or RH (n=64) with or without tailored adjuvant therapy between 2002 and 2011 at Keimyung University Dongsan Medical Center. Patients in RH group was divided into those undergoing surgery alone (n=26) and those undergoing surgery with adjuvant therapy (n=38).

Results: The median follow up period was 66 months. The 5-year OS by treatment modality was 88.7% for the 64 patients in the RH group and 72.8% for 49 patients in the CCRT group (P=0.044). The 5-year PFS was 82.3% and 65.6% after RH group and CCRT group (P=0.048), respectively. Grade 3?4 complication was less frequent after RH alone (7.7%) than RH with adjuvant therapy (34.2%) or CCRT group (28.6%) (P=0.047).

Conclusion: The RH group seems to be superior to the CCRT group in oncologic outcomes. However, considering the selection bias including tumor size, lymph node meta, and parametrial invasion in pretreatment magnetic resonance imaging, both treatment modalities are reasonable and feasible in cervical cancer IB2 and IIA. It is important to choose the appropriate treatment modality considering the age and general condition of the patient. Randomized controlled study is needed to confirm the result of our study and determine the optimal treatment.

키워드

Cervical cancer; Concurrent chemoradiotherapy; Hysterectomy
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