The impact of sequential chemoradiotherapy versus concurrent chemoradiotherapy on prognosis in adjuvant treatment after radical hysterectomy for cervical cancer

This study aimed to compare the efficacy and toxicity of sequential chemoradiotherapy (SCRT) versus concurrent chemoradiotherapy (CCRT) in patients receiving adjuvant treatment after radical hysterectomy for cervical cancer. A retrospective analysis was conducted on 236 patients who underwent radical hysterectomy for cervical cancer in our gynecology, oncology, and radiotherapy departments from February 2018 to January 2022. Patients were divided into two groups based on their postoperative adjuvant treatment: the SCRT group (n = 112) and the CCRT group (n = 124). Follow-up evaluations were conducted over a period of 3 years. Patient data, including demographic characteristics, cancer characteristics, efficacy, toxicity assessment, and survival outcomes, were collected through the medical record system. Significant differences were noted in grade 3–4 treatment-related toxicities, with CCRT showing higher rates of leucopenia (P = 0.003) and nausea/vomiting (P = 0.003). In terms of survival outcomes, while overall survival rates were similar between the two groups, the CCRT group demonstrated significantly better progression-free survival (PFS) (34.89 ± 3.76 months vs. 33.58 ± 5.42 months, P = 0.033) compared to the SCRT group. CCRT is associated with better PFS but also higher rates of severe leucopenia and nausea/vomiting. Multivariate analysis identified CCRT (Hazard Ratio [HR] = 0.522), well-differentiated tumor grading (HR = 0.535), early-stage disease (FIGO stage I) (HR = 0.322), and better performance status (ECOG score of 0) (HR = 0.266) as independent protective factors against shorter PFS (P < 0.05). In the adjuvant treatment after radical hysterectomy for cervical cancer, CCRT is associated with better PFS but also higher rates of severe leucopenia and nausea/vomiting. CCRT may offer a therapeutic advantage in delaying disease progression and extending survival times, despite its increased toxicity.