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

Journal of Gynecologic Oncology
2017년 28권 3호 p.6 ~ p.6
 ( Landoni Fabio ) - European Institute of Oncology Division of Gynecology

 ( Colombo Alessandro ) - Hospital of Lecco Division of Radiotherapy
 ( Milani Rodolfo ) - University of Milan-Bicocca Obstetrics and Gynecology Clinic
 ( Placa Franco ) - Hospital of Lecco Division of Radiotherapy
 ( Zanagnolo Vanna ) - European Institute of Oncology Division of Gynecology
 ( Mangioni Costantino ) - University of Milan-Bicocca Obstetrics and Gynecology Clinic

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.

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