Propensity Score Matched Study of Tri-Weekly vs. Weekly Platinum-Based Chemotherapy Concurrent with Radiotherapy in the Treatment of Locally Advanced Cervical Cancer

Kullathorn  Thephamongkhol; Arb-aroon  Lertkhachonsuk; Chomporn  Sitathanee; Petch  Alisanant; Napapat  Amornwichet; Chonlakiet  Khorprasert; Jidapa  Bridhikitti; Pornpim  Korpraphong; Kobkun  Muangsomboon; Sith  Phongkitkarun; Saowanee  Srirattanapong; Duangkamon  Prapruttam; Thaworn  Dendumrongsup; Kewalee  Sasiwimonphan; Chamnan  Tanprasertkul; Mantana  Dhanachai; Jayanton  Patumanond; Jiraporn  Setakornnukul

doi:10.33192/Smj.2022.31

Authors

Kullathorn Thephamongkhol Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok
Arb-aroon Lertkhachonsuk Gynecological Oncology Unit, Department of Obstetrics and Gynecology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok
Chomporn Sitathanee Division of Radiation and Oncology, Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University
Petch Alisanant Division of Therapeutic Radiology and Oncology, Department of Radiology, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University
Napapat Amornwichet Division of Therapeutic Radiology and Oncology, Department of Radiology, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University
Chonlakiet Khorprasert Division of Therapeutic Radiology and Oncology, Department of Radiology, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University
Jidapa Bridhikitti Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Songklanagarind Hospital, Prince of Songkla University, Hat Yai
Pornpim Korpraphong Division of Diagnostic Radiology, Department of Radiology, Faculty of Medicine, Siriraj Hospital, Mahidol University
Kobkun Muangsomboon Division of Diagnostic Radiology, Department of Radiology, Faculty of Medicine, Siriraj Hospital, Mahidol University
Sith Phongkitkarun Diagnostic Radiology Unit, Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University
Saowanee Srirattanapong Diagnostic Radiology Unit, Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University
Duangkamon Prapruttam Diagnostic Radiology Unit, Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University
Thaworn Dendumrongsup Abdominal Imaging Section, Department of Radiology, Faculty of Medicine, Songklanagarind Hospital, Prince of Songkla University, Hat Yai
Kewalee Sasiwimonphan Division of Diagnostic Radiology, Department of Radiology, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University
Chamnan Tanprasertkul Minimally Invasive Gynecologic Unit, Department of Obstetrics and Gynecology, Thammasat University, Pathum Thani / Center of Excellence in Applied Epidemiology, Thammasat University, Pathum Thani
Mantana Dhanachai Division of Radiation and Oncology, Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University
Jayanton Patumanond Center for Clinical Epidemiology and Clinical Statistics, Faculty of Medicine, Chiang Mai University, Chiang Mai
Jiraporn Setakornnukul Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok

DOI:

https://doi.org/10.33192/Smj.2022.31

Keywords:

Cervical cancer, chemotherapy, radiotherapy, weekly regimen, tri-weekly regimen

Abstract

Objective: To compare tumor control and toxicity between tri-weekly chemotherapy and weekly platinum-based chemotherapy in locally advanced cervical cancer using the propensity score matching method.
Material and Methods: DESIGN: Retrospective cohort with propensity score matched population. SETTING: Four university hospitals. PARTICIPANTS: 781 advanced local cervical cancer patients. INTERVENTION: tri-weekly platinum-based chemoradiotherapy versus weekly chemoradiotherapy OUTCOMES: Overall survival (OS), local recurrence-free survival (LRFS), regional recurrence-free survival (RRFS), distant metastasis-free survival (DMFS), and toxicity, including hematological and renal toxicity.
Results: Overall median follow-up time was 59.5 months. After the propensity score matching process was completed, 326 patients were analyzed (163 in each group). The five-year OS was 66% and 64% (p 0.630); five-year LRFS was 85% and 81% (p 0.209); five-year RRFS was 89% and 94% (p 0.307); and five-year DMFS was 75% and 79% (p 0.420) in the tri-weekly and weekly groups, respectively. The patients in the tri-weekly and the weekly group had grade 2-3 neutropenia (10.5% vs 2.5%). The other toxicities appeared to be similar in both groups in terms of white blood count, platelet and creatinine.
Conclusion: There was a potential small benefit of local control (4%) and overall survival (2%) with the tri-weekly regimen but we could not demonstrate statistical significance. However, this came at the price of an increase of 7% to 8% in grade 2-3 neutropenia.

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