Concurrent cisplatin chemotherapy with intensity-modulated radiotherapy followed by consolidation chemotherapy in early-stage cervical cancer patients with high-risk factors after radical hysterectomy.

OBJECTIVES

To evaluate the efficacy and toxicity of consolidation chemotherapy (C-CT) following concurrent cisplatin chemotherapy combined with intensity-modulated radiotherapy (IMRT) in patients with early-stage cervical cancer who present high-risk factors (HRFs).

METHODS

Between 2013 and 2023, a total of 190 women were included in this retrospective study. Among these, 82 patients received postoperative concurrent chemoradiotherapy (CCRT) with weekly cisplatin and IMRT (45.0-50.4 Gy), followed by C-CT, while 108 patients received CCRT alone. A propensity score matching (PSM) was performed with a ratio of 1:1. Clinical parameters, overall survival (OS), and relapse-free survival (RFS) were analyzed for both groups.

RESULTS

The median follow-up duration was 50.2 months. The 4-year OS rates were 88.7% in the C-CT group and 87.9% in the CCRT-only group (p = 0.886). The 4-year RFS rates were 76.3% for the C-CT group and 80.5% for the CCRT-only group (p = 0.289). In patients with three or more positive lymph nodes, C-CT was associated with significantly improved OS compared to the CCRT-only group (HR 0.14, 95% CI 0.02-0.88, p = 0.036), while RFS showed no significant difference (HR 0.80, 95% CI 0.27-2.32, p = 0.676). However, the incidence of grade 3/4 hematologic toxicity was higher in the C-CT group (16.8% vs. 1.7%, p = 0.009).

CONCLUSIONS

Our study found that C-CT following concurrent cisplatin chemotherapy with IMRT did not confer additional benefits over CCRT alone in the majority of early-stage cervical cancer patients with HRFs, except in those with three or more positive lymph nodes.