Post-operative radiotherapy in patients with early stage cervical cancer

• Between 1970 and 1990, both tumour recurrence and mortality showed a remarkable decrease.
• The major associated change in treatment policy was addition of a local vaginal vault brachytherapy boost.
• Chemotherapy did not have a major impact on survival, but did increase toxicity.

ObjectiveThe aim of this study is to investigate the impact of treatment policy changes in cervical cancer patients treated with adjuvant (chemo) radiotherapy.MethodsBetween 1970 and 2007, 292 patients received adjuvant radiotherapy after a radical hysterectomy with pelvic lymphadenectomy for early stage cervical carcinoma. All patients received pelvic radiotherapy (40 Gy–46 Gy in 1.8 Gy–2 Gy/fraction). Vaginal vault brachytherapy boost (10–14 Gy) was increasingly used for patients with high-risk factors, and since 1993 systematically applied in patients with at least 2 of the 3 risk factors: adenocarcinoma, nodal involvement and parametrial invasion. Cisplatin-based chemotherapy was introduced in this group of patients from 2000.ResultsThe 5-year cumulative risk of local recurrence (CRLR) was 13% (95%CI 9%–17%), resulting in an overall 5-year survival (OS) of 78% (95%CI 83%–73%). Since 1970, the OR for the 5-year locoregional recurrence risk (LRR) decreased from 2.5 to 1.15 (linear-OR = − 0.02/year). The OR for the 5-year mortality risk reduced from 2.2 in 1970 to 1.0 in 2007 (linear-OR = − 0.03/year). The largest risk reductions were observed before 1990 with a minor rise after 2002. The risk of severe late toxicity reduced from 1.8% to 1.5% (linear-OR = − 0.03/year). The addition of concomitant adjuvant chemotherapy since 2000 may have benefited a subgroup of patients with squamous cell carcinoma, but not the patients with adenocarcinoma, and after introduction of chemotherapy the risk of severe late toxicity tripled from 2% to 7%.ConclusionSince 1970, tumour recurrence risk and mortality have decreased, as radiation dose increased. The potential benefit of concomitant adjuvant chemotherapy could not be demonstrated in this nonrandomized study.