The prognosis of "sandwich" mode of postoperative chemotherapy and radiation in patients with locally advanced cervical cancer

Objective This study aims to evaluate the survival outcome between different postoperative radiation and chemotherapy modes in locally advanced cervical cancer (LACC). Methods This study is a retrospective cohort study. A total of 150 patients with LACC underwent radical hysterectomy combined with postoperative radiation and /or chemotherapy from October 2009 to October 2019. Of those, 101 patients who received "sandwich" adjuvant chemotherapy and radiation (SCR) were enrolled into group A and 49 patients who received simple radiation were enrolled into group B. The primary outcome was the rates of progression-free survival (PFS) and overall survival (OS). Results Of 150 patients, 95.3% (143/150) patients complete the study. The rates of deep myometrial invasion (92% and 72.9%, p = 0.007), lymph vascular invasion positive (74.3% and 26.5%, p = 2.59 x 10(-8)), positive surgical margin (11.9% and 0%, p = 0.012), and lymph-node involvement (40.6% vs. 4.1%, p = 4.0 x 10(-6)) at baseline were higher in the group A than group B. There was no difference between the follow-up time of group A and group B (45.81 +/- 16.83 vs. 45.81 +/- 16.84 months, p = 0.665). After the postoperative adjuvant, group A achieved the comparable PFS to group B [p = 0.40; hazard ratio (HR), 1.45; 95% CI, 0.62-3.38]. The cumulative rate of OS in group A was comparable in group B (p = 0.31; HR, 1.53; 95% CI, 0.68-3.45). Conclusions Postoperative 'sandwich' chemotherapy and radiation could yield a similar survival rate to radiation alone in LACC women with high-risk factors such as deep interstitial infiltration, lymphatic vascular space infiltration, positive resection margin, and lymph-node metastasis.