The aim of this multi-institutional study was to determine the prognostic impact of tumour parameters, such as tumour size (TS), tumour volume (TV), and marker expression, on survival during radiation therapy (RT) for cervical cancer patients.

A total of 231 patients with histologically confirmed cervical cancer, classified as Federation of Gynecology and Obstetrics (FIGO) Ib2-IVa, were enrolled in this study. Pre- and mid-RT pelvic magnetic resonance imaging (MRI) and squamous cell carcinoma antigen (SCC-ag) analysis were performed twice, during RT and just before brachytherapy.

The median follow-up time was 27.8 months (range, 2–116 months). Multivariate analysis revealed that stage (odds ratio [OR], 2.936 and 95% confidence interval [CI], 1.119–7.707; P = 0.029), tumour volume reduction rate (TVRR) (OR, 3.435 and 95% CI, 1.062–11.106; P = 0.039), and SCC-ag reduction rate (SCCRR) (OR, 5.104 and 95% CI, 1.769–14.727; P = 0.003) were independently associated with overall survival (OS), while pre-RT TS (OR, 2.148 and 95% CI, 1.221–3.810; P = 0.009), mid-RT TV (OR, 3.106 and 95% CI, 1.685–5.724; P < 0.0001) and SCCRR (OR, 1.954 and 95% CI, 1.133–3.369; P = 0.016) were associated with progression-free survival (PFS). Based on the prognostic factor analysis, patients with the highest prognostic risk score of 3 showed poorer overall survival and progression free survival than patients with lower prognostic risk scores.

We identified that tumour parameters such as TVRR, SCCRR, pre-RT TS, and mid-RT TV areindependent and strong prognostic parameters for patients with cervical cancer receiving RT. This scoring system-based prognostic factor analysis could be used to help develop optimized treatment plans for cervical cancer patients during RT.