Comparison of radiation therapy alone and concurrent chemoradiation therapy in stage III cervical cancer: A multicenter retrospective study

Objective. To evaluate whether concurrent chemoradiation therapy (CRT) improves overall survival as compared to radiation therapy (RT) alone in stage III cervical cancers. Design. A multicenter retrospective review. Setting. Nine tertiary medical centers in Korea. Population. A total of 277 patients treated for stage III cervical cancer without para-aortic lymph node (PALN) metastasis based on clinical staging workup from 1996 to 2003. Methods. Medical and histopathological record review. Main outcome measures. Disease-specific overall survival. Results. CRT and RT alone were performed in 172 and 105 patients, respectively. There was no significant difference in disease-specific overall survival between the CRT and RT alone arms based on clinical staging workup, even though the CRT arm was characterized by younger age, more favorable performance status and lower pretreatment blood urea nitrogen level as compared to the RT alone arm. In the CRT arm, three patients succumbed to treatment-related death. Conclusion. CRT does not improve the overall survival rate in stage III cervical cancer as compared to RT alone based on clinical staging workup for PALN status. Special care needs to be taken regarding optimal dose and duration of RT, use of brachytherapy, anemia control and accurate pretreatment staging workup to improve survival outcome in patients with stage III cervical cancer.