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Randomized Controlled Trial
. 2017 May;28(3):e34.
doi: 10.3802/jgo.2017.28.e34. Epub 2017 Feb 24.

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

Fabio Landoni  1 , Alessandro Colombo  2 , Rodolfo Milani  3 , Franco Placa  2 , Vanna Zanagnolo  4 , Costantino Mangioni  3
Affiliations
Randomized Controlled Trial

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

Fabio Landoni et al. J Gynecol Oncol. 2017 May.

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.

Keywords: Locally Advanced; Radiotherapy; Surgery; Uterine Cervical Neoplasms.

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Conflict of interest statement

No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1
Fig. 1
Trial profile. See original paper [1]. FIGO, International Federation of Gynecology and Obstetrics; RT, radiotherapy.
Fig. 2
Fig. 2
Overall survival (A) and disease-free survival (B). OP, surgery; RT, radiotherapy.
Fig. 3
Fig. 3
Overall survival for squamous cell carcinoma (A) and adenocarcinomas (B). OP, surgery; RT, radiotherapy.
See this image and copyright information in PMC

References

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