The Relationship Between Histopathological Factors and Types of Radiotherapy on Treatment Success and Survival in Patients with Advanced Cervical Cancer

Abstract

Background: Cervical cancer remains a global health problem, particularly in low- and middle-income countries. Histopathological subtypes and types of radiotherapy are thought to play a role in treatment success and survival outcomes in patients with advanced-stage cervical cancer.Objective: To analyze the relationship between histopathological subtypes and types of radiotherapy with treatment success and two-year survival rates in patients with advanced-stage cervical cancer.Methods: A retrospective study was conducted using medical records of patients with stage IIB–IIIB cervical cancer who completed radiotherapy at Dr. Kariadi General Hospital Semarang between 2017 and 2022. Survival analysis was performed using the Kaplan–Meier method and Chi-square test.Results: A total of 938 patients met the inclusion criteria, consisting of 243 adenocarcinoma and 695 squamous cell carcinoma cases. No significant association was found between histopathological subtype and mortality (p=0.970; RR 0.99; 95% CI 0.82–1.19). The mean survival time for adenocarcinoma was 18.87 months with a two-year survival rate of 62.1%, while for squamous cell carcinoma it was 18.68 months with a survival rate of 61.7% (p=0.852). In contrast, a significant association was observed between the type of radiotherapy and mortality. Patients who received box system therapy had a higher risk of death (58.4%) compared with those who underwent intracavitary brachytherapy (36.0%) (p<0.001; RR 1.62; 95% CI 1.33–1.98).Conclusion: Histopathological subtype (adenocarcinoma vs. squamous cell carcinoma) did not significantly affect the two-year survival of patients with advanced-stage cervical cancer. However, the type of radiotherapy played a critical role, with intracavitary brachytherapy providing better survival outcomes compared with the box system. Optimization of radiotherapy techniques is crucial to improving prognosis in patients with advanced cervical cancer.