Presently, the treatment of localized adenocarcinoma cervix patients is the same as squamous cell carcinoma. This study analyzes the long-term survival outcome and pattern of failure of adenocarcinoma patients treated at our institute.
All ladies diagnosed and treated with localized adenocarcinoma cervix at our institute between 2012 and 2018 were included. These patients were followed up till January 2022. The stages of all patients at the time of diagnosis were restaged according to FIGO 2018. The patient, treatment, and follow-up details were collected from the electronic filing system. Lost-to-follow-up patients were contacted through telephone. The statistical analysis was done using SPSS 23.0.
Adenocarcinoma constituted 7.8% (66 out of 847 patients) of the entire cervical cancer patients detected during the study period – 44% of patients presented with either stage I or II. There were no patients with stage IVa. The median age was 53.5 years (66.7 % were 55 years or less). 69.7% of adenocarcinoma were HPV-associated. The treatment modalities undergone by these patients include radical concurrent chemoradiation and brachytherapy (36.4%), surgery alone (30.3%), surgery followed by adjuvant radiation in (15.2%), and surgery followed by concurrent chemoradiation in (18.2%). All the patients who underwent radiotherapy used the intensity-modulated radiotherapy technique for external beam radiotherapy and image-based adaptive brachytherapy. A few patients (16.7%) received neoadjuvant chemotherapy (NACT) before undergoing curative treatments. The median follow-up period was 54 months. The 10-year overall survival (OS) was 62.2% (84.2% in stage I, 56% in stage II, and 53.1% in stage III). The OS of those who received NACT was 72.7 percent versus 59.9% who did not receive it. Most of the patients who recurred had distant metastasis (64.3%), and the median disease-free interval of those who had distant metastasis was 7 months (2 - 30).
Further molecular studies should be done to better understand this distinctly different subset of cervical cancer patients to tailor the treatment modalities.
The authors.
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All authors have declared no conflicts of interest.