Adjuvant chemotherapy versus adjuvant concurrent chemoradiotherapy after radical surgery for early-stage cervical cancer: a randomized, non-inferiority, multicenter trial

Cervical cancer is the fourth most common cancer in women globally and the third leading cause of cancer-related mortality among women. Despite advancements in HPV vaccines and screenings, there's a need for effective adjuvant treatments, especially for younger patients emphasizing genital and endocrine function preservation. The standard treatment per NCCN guidelines is radical hysterectomy and pelvic lymph node dissection, followed by concurrent chemoradiotherapy (CCRT) for patients with surgical-pathological risk factors.

Danhui Weng et al., at Department of Obstetrics and Gynecology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, China, conducted a randomized, non-inferiority, multicenter trial that focused on adjuvant chemotherapy versus adjuvant concurrent chemoradiotherapy after radical surgery for early-stage cervical cancer.

The study included patients aged 18–65 with stage IB–IIA cervical cancer who underwent radical hysterectomy and were at risk for adjuvant therapy. Patients were randomly assigned to receive either adjuvant chemotherapy (cisplatin and paclitaxel) or standard adjuvant CCRT.

The primary endpoint was progression-free survival (PFS), with secondary endpoints including overall survival (OS), treatment-related toxicity, and quality of life.

A total of 337 patients were recruited, with 329 included in the intention-to-treat (ITT) population. There was no significant difference in PFS between the adjuvant chemotherapy and CCRT groups, with three-year PFS rates at 91.9% for both. OS rates also did not significantly differ between the two groups. Treatment-related toxicities were observed, with lower-limb lymphedema and bladder dysfunction being common post-surgery complications. Quality of life assessments showed that chemotherapy maintained better ovarian function and fewer menopausal symptoms compared to CCRT.

The study indicates that adjuvant chemotherapy alone is non-inferior to CCRT in terms of PFS for early-stage cervical cancer patients with risk factors. The benefits of chemotherapy include fewer long-term complications and better quality of life outcomes.

Adjuvant chemotherapy is a viable alternative to CCRT, offering similar efficacy in PFS and OS with the added benefits of better quality of life and ovarian function preservation.

The findings are significant for clinical practice, especially considering the lower costs of chemotherapy and its suitability for areas lacking radiotherapy equipment.