International Journal of Radiation Oncology*Biology*Physics
Clinical InvestigationLong-Term Outcome and Prognostic Factors for Adenocarcinoma/Adenosquamous Carcinoma of Cervix After Definitive Radiotherapy
Introduction
Adenocarcinoma/adenosquamous carcinoma (AC/ASC) of the cervix are relatively uncommon histologic subtypes of cervical cancer. The incidence of cervical cancer has decreased during the past 40 years with the introduction of Papanicolaou smear screening. However, recently, the absolute incidence rate of AC/ASC and its relative proportion compared with squamous cell carcinoma (SCC) have increased in many countries 1, 2. In general, patients with AC/ASC undergo the same first-line treatment as those with SCC. However, it remains uncertain whether AC/ASC patients have a worse prognosis than those with SCC and whether they should follow the same treatment strategy. In some reports, patients' survival for both histologic subtypes were similar 3, 4. However, in others, the AC/ASC patients had worse outcomes 5, 6, 7. Despite the analysis and publication of various prognostic factors for AC/ASC, those related to the outcome of patients primarily treated with radiotherapy (RT) are not well established, because many studies included heterogeneous patient populations, were published in early eras, or had small case numbers. Because RT is a major treatment modality for AC/ASC of the cervix, it is necessary to clarify these issues using on a larger patient population.
We have previously reported the patient characteristics and treatment results for 53 AC/ASC patients primarily treated with RT between 1990 and 1996. We found that our AC/ASC patients had worse survival rates and inferior local control compared with those with SCC (7). In the present study, we extended our analysis to a larger population of 148 AC/ASC patients primarily treated with RT between 1990 and 2004. The increase in case numbers should enable us to better identify the prognostic factors and determine the salvage rate by surgery for selected patients with local failure. Furthermore, concurrent chemoradiotherapy (CCRT) was not a common practice at the time of our previous report but has become standard treatment since 1999. We therefore tried to analyze the efficacy of CCRT for AC/ASC. The present study, although it was a retrospective analysis, included a relatively large series and might help us understand the clinical behavior of AC/ASC, the response to RT/CCRT, and provide useful information for designing appropriate treatment strategies.
Section snippets
Patients and staging workup
Between 1990 and 2004, 158 patients with International Federation of Gynecology and Obstetrics Stage I-IVA AC/ASC of the cervix primarily underwent RT at Chang Gung Memorial Hospital (Lin-Kou, Taiwan). Only 148 patients who completed the full RT course were included in the present study. For Stage IB and IIA, bulky tumor was defined as a tumor diameter >4 cm by clinical palpation. The staging workup included the usual radiographs, laboratory analysis, and computed tomography/magnetic resonance
Patient characteristics
Of the 148 patients, 90 (61%) had AC and 58 had ASC. The distribution of clinical parameters and treatment-related variables is listed in Table 1 and 2, respectively. The median age was 54 years (range, 32–89), 8 years younger than our patients with SCC who were primarily treated with RT (8). The percentage of well/moderately differentiated histologic features was greater for AC patients (62%) than for ASC patients (28%). Most (76%) patients had Stage IB-IIA bulky or greater disease. Elevation
Discussion
Patients with AC/ASC of the cervix have been reported to have a worse prognosis than those with SCC 5, 7. The present updated report of 148 AC/ASC patients has provided additional confirmation. The difference in the 5-year RFS rates between the SCC and AC/ASC patients was 20–35% and was statistically significant in a stage-by-stage comparison. The survival rate of patients with SCC in the present updated analysis was similar to that of our previous reports 7, 8, suggesting the reproducibility
References (26)
- et al.
The rising incidence of adenocarcinoma relative to squamous cell carcinoma of the uterine cervix in the United States—A 24-year population-based study
Gynecol Oncol
(2000) - et al.
Changing rates of adenocarcinoma and adenosquamous carcinoma of the cervix in England
Lancet
(2001) - et al.
Adenocarcinoma as an independent risk factor for disease recurrence in patients with stage IB cervical carcinoma
Gynecol Oncol
(1995) - et al.
Risk stratification of patients with advanced squamous cell carcinoma of cervix treated by radiotherapy alone
Int J Radiat Oncol Biol Phys
(2005) - et al.
Toxicity criteria of the Radiation Therapy Oncology Group (RTOG) and the European Organization for Research and Treatment of Cancer (EORTC)
Int J Radiat Oncol Biol Phys
(1995) - et al.
Stage I adenocarcinoma of the cervix: Metastatic potential and patterns of dissemination
Am J Obstet Gynecol
(1984) - et al.
Differential cyclooxygenase-2 expression in squamous cell carcinoma and adenocarcinoma of the uterine cervix
Int J Radiat Oncol Biol Phys
(2004) - et al.
Prognostic assessment of tumor regression after external irradiation for cervical cancer
Int J Radiat Oncol Biol Phys
(1992) - et al.
Method and timing of tumor volume measurement for outcome prediction in cervical cancer using magnetic resonance imaging
Int J Radiat Oncol Biol Phys
(2002) - et al.
The prognostic significance of tumor volume regression during radiotherapy and concurrent chemoradiotherapy for cervical cancer using MRI
Gynecol Oncol
(2007)
Recurrent squamous cell carcinoma of cervix after definitive radiotherapy
Int J Radiat Oncol Biol Phys
A randomized trial of concurrent chemoradiotherapy versus radiotherapy in advanced carcinoma of the uterine cervix
Gynecol Oncol
Concurrent weekly cisplatin plus external beam radiotherapy and high-dose rate brachytherapy for advanced cervical cancer: A control cohort comparison with radiation alone on treatment outcome and complications
Int J Radiat Oncol Biol Phys
Cited by (0)
Conflict of interest: none.