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Comment & Response
July 15, 2021

Sequential Chemoradiotherapy vs Concurrent Chemoradiotherapy or Radiotherapy Alone in Adjuvant Treatment for Patients With Cervical Cancer—Reply

Author Affiliations
  • 1Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
JAMA Oncol. 2021;7(9):1404-1405. doi:10.1001/jamaoncol.2021.2113

In Reply We truly appreciate the comments from Dr Sari et al regarding our randomized clinical trial1 and for indicating previous valuable works in the field. Indications and modalities of adjuvant treatment for early-stage cervical cancer, such as radiotherapy (RT) or concurrent chemoradiotherapy (CCRT), were debatable because the evidence was limited, especially at the time the study was designed and initiated 13 years ago. For example, according to German Gynecological Oncology Working Group (Arbeitsgemeinschaft Gynäkologische Onkologie) guidelines,2 patients with 1 intermediate-risk factor (tumor size > 4 cm, deep stromal invasion, or extensive lymphatic vascular involvement) would be indicated to receive CCRT as the adjuvant therapy. However, at least 2 intermediate-risk factors were needed for the indication of adjuvant radiotherapy according to Sedlis criteria.3 Moreover, chemoradiotherapy with weekly single cisplatin has been more widely adopted for primary treatment of locally advanced cervical cancer in clinical practice,4 which to our knowledge has not been investigated in any randomized clinical trials for adjuvant treatment. In the Gynecologic Oncology Group GOG109 study,5 patients received chemoradiotherapy with a combination of fluorouracil and cisplatin but not with weekly cisplatin. Therefore, it was just the rationale and purpose of our study1 to investigate different modalities for risk-adapted postoperative treatment in early-stage cervical cancer.

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