# Adjuvant Chemoradiotherapy or Radiotherapy Alone for Early Squamous Cervical Cancer with a Single Surgical-Pathological High-Risk Factor

## TL;DR

This study finds that adding chemotherapy to radiotherapy after surgery for early cervical cancer with one high-risk factor does not improve survival and may be unnecessary.

## Contribution

The study provides evidence that chemoradiotherapy may not be needed for cervical cancer patients with a single high-risk factor.

## Key findings

- Five-year survival rates were similar between chemoradiotherapy and radiotherapy groups.
- Chemotherapy did not improve recurrence-free or overall survival in this patient subgroup.
- Results support individualized treatment to avoid unnecessary toxicity.

## Abstract

Adjuvant chemoradiotherapy following radical hysterectomy has been shown to be effective in improving survival rates for patients with early-stage squamous cervical cancer and high-risk features following surgery. However, emerging data suggest that certain subgroups may not benefit from it and may experience unnecessary toxicity and overtreatment. This study analysed 122 patients with squamous cell carcinoma and a single high-risk factor—positive resection margins, parametrial involvement, or pelvic lymph node metastasis. Of these patients, 76 (62%) received adjuvant chemoradiotherapy, while 46 (38%) received adjuvant radiotherapy alone. Inverse probability of treatment weighting (IPTW) was used to adjust for confounding factors. Five-year recurrence-free survival and overall survival rates were comparable between the adjuvant chemoradiotherapy and radiotherapy groups (84% versus 91%; p = 0.49). Our results suggest that adding chemotherapy may not improve survival in this patient group. These findings support a more individualised adjuvant treatment strategy to avoid unnecessary toxicity while maintaining oncological efficacy.

Objective: This study aims to explore the benefit of adjuvant chemoradiotherapy compared with radiotherapy alone following a radical hysterectomy with pelvic lymphadenectomy. The study focuses on patients with clinically early-stage squamous cervical cancer who have a single high-risk factor postoperatively. Methods: This retrospective study included women diagnosed between 2001 and 2018, with: (1) clinical tumour (cT) stage 1A2–2A2, (2) cervical squamous carcinoma, (3) treated with radical hysterectomy and pelvic lymphadenectomy (4) followed by adjuvant (chemo)radiotherapy, and with (5) one high-risk factor (i.e., positive resection margins, parametrial involvement, or pelvic lymph node metastases). Recurrence-free and overall survival were estimated using Kaplan−Meier and Cox proportional hazards analyses. Inverse probability treatment weighting was used to adjust for confounding. Results: Of the 122 patients with squamous cell carcinoma and one high-risk factor, 76 (62%) received adjuvant chemoradiotherapy and 46 (38%) received adjuvant radiotherapy alone. Larger tumour size, tumour grade 3, and pathological parametrial invasion were more common in the radiotherapy group, while patients who received chemoradiotherapy were more likely to have multiple lymph node metastases. The unadjusted and for confounding adjusted 5-year survival rates were comparable between the adjuvant chemoradiotherapy and radiotherapy groups for both recurrence-free survival (85% versus 87%; p = 0.58, and 84% versus 91%; p = 0.49) and overall survival (84% versus 87%; p = 0.51, and 84% versus 91%; p = 0.49). Conclusions: Adding chemotherapy to radiotherapy may not improve survival of patients with early squamous cervical cancer treated with radical hysterectomy and pelvic lymphadenectomy, and with a single postoperative high-risk factor.