ArticlesRandomised study of radical surgery versus radiotherapy for stage Ib-IIa cervical cancer
Introduction
Stage Ib and IIa carcinoma of the cervix can be cured by radical surgery or radiotherapy with similar effectiveness, but the rate and types of complications differ. Radiotherapy is feasible and effective in almost all patients; 5-year survival after this therapy ranges from 78% to 91%.1, 2 By contrast, radical surgery affords the opportunity to study pathological findings, so that groups of at-risk patients who could benefit from adjuvant treatment can be identified. The 5-year cure rate after surgery for early-stage cervical tumours ranges from 54% to 90%; in most cases this rate is achieved with adjuvant therapy.3, 4 The treatment of choice will depend on the policy of the institution, the gynaecologist or radiation oncologist involved, and the age and the general health of the patient.
Apart from Newton's study5 about stage-I diseases, there have been no randomised studies to compare radiotherapy with radical surgery in one institution over a short period of time. We conducted a prospective, randomised study to compare external and internal radiotherapy with radical hysterectomy and node dissection. Our main aim was to evaluate 5-year survival and the rate and pattern of complications and recurrences associated with each procedure.
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Methods
Between September, 1986, and December, 1991, 578 patients with primary invasive cervical cancer were referred to the Departments of Obstetrics and Gynecology and Radiation Oncology, at the Istituto di Scienze Biomediche S Gerardo, University of Milan, Monza. All patients received standard pretreatment evaluation, which included complete blood analysis, intravenous pyelogram, lymphangiography, cystoscopy, chest radiography, and other tests when indicated. The cervical diameter was assessed by
Results
The trial profile shows the flow of patients in the study (figure 1). Of the 468 patients with FIGO stage Ib or IIa cervical cancer, 125 were excluded because of age (< 30 years, >70 years; n=43), medical illness (n=54), previous or concurrent malignant disease (n=21), or the referring physician's or patient's preference for surgery, radiotherapy, or chemoradiotherapy (n=7).
Thus, 343 patients were randomised: 172 to radical surgery and 171 to radiotherapy. After randomisation, there were six
Discussion
Our review of the published research suggests that cure rates are similar for patients with stage-I cervical cancers who undergo surgery or radiotherapy. Newton5 reported that the 5-year survival rate for 119 patients with stage-I disease accrued over 10 years in a partly randomised study was 81% for radical surgery and 74% for radiotherapy; this difference was not significant. Morley and Seski's11 study, of 446 patients with stage-Ib disease recruited between 1945 and 1975 and treated with
References (18)
Complications following radiation therapy in carcinoma of the cervix and their treatment
Am J Obstet Gynecol
(1964)Radical hysterectomy or radiotherapy for stage I cervical cancer
Am J Obstet Gynecol
(1975)- et al.
A glossary for reporting complications of treatment in gynecological cancers
Radiother Oncol
(1993) - et al.
Radical pelvic surgery versus radiation therapy for stage I carcinoma of the cervix (exclusive of microinvasion)
Am J Obstet Gynecol
(1976) - et al.
Clinical significance of adenocarcinoma of the cervix
Am J Obstet Gynecol
(1969) - et al.
Adenocarcinoma of the uterine cervix: lack of evidence for a poor prognosis
Radiother Oncol
(1988) - et al.
Preoperative adjuvant chemotherapy in the treatment of cervical cancer stage Ib, IIa and IIb with bulky tumor
Gynecol Oncol
(1988) - et al.
Radical hysterectomy and pelvic lymphadenectomy versus radiation therapy for small (J3 cm) stage Ib cervical carcinoma
Am J Clin Oncol
(1988) Is pelvic radiation beneficial in the postoperative management of stage Ib squamous-cell carcinoma of the cervix with pelvic node metastasis treated by radical hysterectomy and pelvic lymphadenectomy?
Gynecol Oncol
(1980)
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