Survival Outcomes of Advanced and Recurrent Cervical Cancer Patients Treated with Chemotherapy: Experience of Northern Tertiary Care Hospital in Thailand

  • Boupaijit, Kuanoon ;
  • Suprasert, Prapaporn
  • Published : 2016.04.11


Chemotherapy is the primary treatment for advanced and recurrent cervical cancer. To evaluate the survival outcomes of chemotherapy and the prognostic factors in this setting, we conducted a retrospective study by reviewing the medical records of advanced and recurrent cervical cancer patients treated with systemic chemotherapy at our institute between January, 2008 and December, 2014. One hundred and seventy-three patients met the criteria with a mean age of 50.9 years. 4.1% of them were HIV positive. The most common initial stage was stage IVB (30.1%) and the most common histology was squamous cell carcinoma (68.6%). Ninety-two (53.2%) patients were previously treated with concurrent chemoradiation with 53% developing combined sites of recurrence. The median recurrence free interval was 16.7 months. Cisplatin + 5 fluorouracil (5FU) (53.2%) was the most frequent first line chemotherapy followed by carboplatin + paclitaxel (20.2%) with an objective response of 39.3%. Seventy-two patients received subsequent chemotherapy. The median overall survival of all studied patients was 13.2 months. Only a recurrence free interval of less than 12 months was an independent prognostic factor for survival outcome. In conclusion, chemotherapy treatment for advanced and recurrent cervical cancer patients showed modest efficacy with a shorter recurrence free survival less than 12 months as a significant poor prognosis factor.


Cervical cancer;advanced stage;recurrence;chemotherapy;prognosis


  1. Ferlay J, Soerjomataram I, Ervik M, et al (2013). GLOBOCAN 2012 v1.0, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 11 [Internet]. Lyon, France: International Agency for Research on Cancer.
  2. Eskander RN, Tewari KS (2014). Chemotherapy in the treatment of metastatic, persistent, and recurrent cervical cancer. Curr Opin Obstet Gynecol, 26, 314-21
  3. Kaern J, Trope C, Sundfoer K, et al (1996). Cisplatin/5-fluorouracil treatment of recurrent cervical carcinoma: a phase II study with long-term follow-up. Gynecol Oncol, 60, 387-92.
  4. Kamura T, Ushijima K (2013). Chemotherapy for advanced or recurrent cervical cancer. Taiwan J Obstet Gynecol, 52, 161-4.
  5. Kitagawa R, Katsumata N, Shibata T, et al (2015). Paclitaxel Plus Carboplatin Versus Paclitaxel Plus Cisplatin in Metastatic or Recurrent Cervical Cancer: The Open-Label Randomized Phase III Trial JCOG0505. J Clin Oncol, 33, 2129-35.
  6. Long HJ 3rd, Bundy BN, Grendys EC Jr, et al (2005). Randomized phase III trial of cisplatin with or without topotecan in carcinoma of the uterine cervix: a Gynecologic Oncology Group Study. J Clin Oncol, 23, 4626-33.
  7. Moore DH, Blessing JA, McQuellon RP, et al (2004). Phase III study of cisplatin with or without paclitaxel in stage IVB, recurrent, or persistent squamous cell carcinoma of the cervix: a gynecologic oncology group study. J Clin Oncol, 22, 3113-9.
  8. Monk BJ, Sill MW, McMeekin DS, et al (2009). Phase III trial of four cisplatin-containing doublet combinations in stage IVB, recurrent, or persistent cervical carcinoma: a gynecologic oncology group study. J Clin Oncol, 27, 4649-55.
  9. Moore DH, Tian C, Monk BJ, et al (2010). Prognostic factors for response to cisplatin-based chemotherapy in advanced cervical carcinoma: a Gynecologic Oncology Group Study. Gynecol Oncol, 116, 44-9.
  10. Micha JP, Sassoon AF, Wong H, et al (2015). Prolonged remission of recurrent cervical carcinoma following paclitaxel and carboplatin chemotherapy with paclitaxel maintenance chemotherapy. Anticancer Drugs, 26, 793-6.
  11. Mackay HJ, Wenzel L, Mileshkin L(2015). Nonsurgical management of cervical cancer: locally advanced, recurrent, and metastatic disease, survivorship, and beyond. Am Soc Clin Oncol Educ Book, 299-309.
  12. Peiretti M, Zapardiel I, Zanagnolo V, et al (2012). Management of recurrent cervical cancer: a review of the literature. Surg Oncol, 21, 59-66.
  13. Pfaendler KS, Tewari KS (2016). Changing paradigms in the systemic treatment of advanced cervical cancer. Am J Obstet Gynecol, 214, 22-30.
  14. Tewari KS, Sill MW, Long HJ 3rd, et al (2014). Improved survival with bevacizumab in advanced cervical cancer. N Engl J Med, 370, 734-43.