Randomized study between radical surgery and radiotherapy for the treatment of stage IB–IIA cervical cancer: 20-year update

Fabio Landoni, Alessandro Colombo, Rodolfo Milani, Franco Placa, Vanna Zanagnolo, Costantino Mangioni

Research output: Contribution to journalArticlepeer-review

Abstract

Objective: Stage IB–IIA cervical carcinoma can be equally cured either by radical surgery or radiotherapy (RT). Albeit such policies show the same efficacy, they carry a different morbidity. This is an update after 20 years of a previously published randomized trial of RT vs. surgery in the treatment of stage IB–IIA cervical cancers to assess long-term survival and morbidity and the different pattern of relapse between the 2 modalities. Methods: Between September 1986 and December 1991, women referred for a newly diagnosed stage IB and IIA cervical carcinoma were randomized to radical surgery or RT. The primary outcome measures were long-term survival and complications rate. The secondary outcome was recurrence of the disease. Results: Three-hundred forty-three eligible women were randomized: 172 to radical surgery and 171 to external RT. Minimum follow-up was 19 years. Thirty-three patients (10%) died of intercurrent disease (31 cases) or fatal complications (2 cases). Twenty-year overall survival is 72% and 77% in the 2 treatment groups (p=0.280), respectively. As a whole, 94 recurrences (28%) were observed. Median time to relapse was 13.5 (surgery group) and 11.5 months (radiotherapy group) (p=0.100), respectively. Multivariate analysis confirms that risk factors for survival are histotype (p=0.020), tumor diameter (p=0.008), and lymph node status (p<0.001). Conclusion: The results of the present study seem to suggest that there is no treatment of choice for early stage cervical carcinoma in terms of survival. Long term follow-up confirms that the best treatment for the individual patient should take into account clinical factors such as menopausal status, comorbidities, histological type, and tumor diameter.

Original languageEnglish
Article numbere34
JournalJournal of Gynecologic Oncology
Volume28
Issue number3
DOIs
Publication statusPublished - May 1 2017

Keywords

  • Locally advanced
  • Radiotherapy
  • Surgery
  • Uterine cervical neoplasms

ASJC Scopus subject areas

  • Oncology
  • Obstetrics and Gynaecology

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