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Logo of jgoJournal of Gynecologic OncologyAims and ScopeInformations for Authorse-SubmissionThis Article
 
J Gynecol Oncol. 2009 June; 20(2): 132.
Published online 2009 June 29. doi:  10.3802/jgo.2009.20.2.132
PMCID: PMC2704997

Differing prognosis of cervical cancer patients with high risk of treatment failure after radical hysterectomy

To the editor: In the article of Kim et al.,1 the authors suggested that there was a subgroup of patients with increased risk of treatment failure after adjuvant concurrent chemoradiation therapy (CCRT) within high-risk group of patients with early-stage cervical cancer. And, they advocated new strategies, such as consolidation chemotherapy after CCRT, in these very high-risk patients.

This study may be informative in that it proposed the selection criteria for more aggressive therapy including consolidation chemotherapy among high-risk cervical cancer patients. However, there are some limitations to be overcome in this study. First, the criteria of dividing patients into two groups were not supported sufficiently. In the present study, high-risk patients who were candidates for adjuvant CCRT were arbitrarily divided into two groups; group A with negative parametrium, negative resection margins, and unilateral pelvic lymph node metastasis (involved lymph nodes ≤ 2), and group B with either bilateral pelvic lymph node involvement or more than 2 lymph node involvement or positive parametrium with lymph node involvement. The selection criteria were based on the results of previous retrospective studies identifying risk factors for recurrence in early-stage cervical cancer after radical hysterectomy and/or postoperative radiation therapy.2-4 These include number of positive lymph nodes (2 or more in most studies), parametrial invasion, tumor size, lymphovascular tumor emboli, and histologic types. Among these, the number of positive lymph nodes, bilaterality of lymph node involvement, and parametrial involvement were selected in this study. Even though a significant difference in survival between the two groups was demonstrated, assessment of potential risk factors, including stage, invasion depth of cervix, and above mentioned variables, for correlation with treatment failure after CCRT using univariate/multivariate analysis is required before developing the selection criteria.

Secondly, there has not been any definite evidence of survival benefit of consolidation chemotherapy after adjuvant CCRT so far. There has been only one prospective study, which showed no survival benefit of consolidation chemotherapy after adjuvant CCRT.5 However, there have been several studies suggesting that the number of chemotherapy cycles may affect survival.6,7 Recently, a phase III randomized study of CCRT with or without adjuvant chemotherapy in high-risk patients with early-stage cervical carcinoma following radical hysterectomy is under development (RTOG-0724). We have to wait for the results of this prospective study and other phase II studies to validate the hypothesis of this study, and to determine which subgroup of patients with early-stage cervical cancer can benefit from more aggressive therapy.

References

1. Kim WY, Chang SJ, Chang KH, Yoo SC, Chun M, Ryu HS. Differing prognosis of cervical cancer patients with high risk of treatment failure after radical hysterectomy warrants trial treatment modification. J Gynecol Oncol. 2009;20:17–21. [PMC free article] [PubMed]
2. Lin HH, Cheng WF, Chan KW, Chang DY, Chen CK, Huang SC. Risk factors for recurrence in patients with stage IB, IIA, and IIB cervical carcinoma after radical hysterectomy and postoperative pelvic irradiation. Obstet Gynecol. 1996;88:274–279. [PubMed]
3. Inoue T, Morita K. The prognostic significance of number of positive nodes in cervical carcinoma stages IB, IIA, and IIB. Cancer. 1990;65:1923–1927. [PubMed]
4. Aoki Y, Sasaki M, Watanabe M, Sato T, Tsuneki I, Aida H, et al. High-risk group in node-positive patients with stage IB, IIA, and IIB cervical carcinoma after radical hysterectomy and postoperative pelvic irradiation. Gynecol Oncol. 2000;77:305–309. [PubMed]
5. Lee JW, Kim BG, Lee SJ, Lee SH, Park CS, Lee JH, et al. Preliminary results of consolidation chemotherapy following concurrent chemoradiation after radical surgery in high-risk early-stage carcinoma of the uterine cervix. Clin Oncol (R Coll Radiol) 2005;17:412–417. [PubMed]
6. Peters WA, 3rd, Liu PY, Barrett RJ, 2nd, Stock RJ, Monk BJ, Berek JS, et al. Concurrent chemotherapy and pelvic radiation therapy compared with pelvic radiation therapy alone as adjuvant therapy after radical surgery in high-risk early-stage cancer of the cervix. J Clin Oncol. 2000;18:1606–1613. [PubMed]
7. Choi CH, Lee JW, Kim TJ, Kim WY, Nam HR, Kim BG, et al. Phase II study of consolidation chemotherapy after concurrent chemoradiation in cervical cancer: preliminary results. Int J Radiat Oncol Biol Phys. 2007;68:817–822. [PubMed]

Articles from Journal of Gynecologic Oncology are provided here courtesy of Asian Society of Gynecologic Oncology & Korean Society of Gynecologic Oncology and Colposcopy