Treatment of stage IB1 cervix cancer: Comparison of radical hysterectomy and radiation

Doll, Kemi M.; Donnelly, Eric D.; Helenowksi, I.; Rosenbloom, Louis; Small, William; Schink, Julian C.; Lurain, John R.

doi:10.1016/j.ygyno.2011.07.077

Cited by 7 publications

(18 citation statements)

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“… 23 A retrospective study from Japan also found no statistically significant difference in survival for stage IA–IIB CC patients who received surgery (n=115) and those who received RT (n=37; 79.9% vs 82.3%, p =0.8524). 24 However, a study by Doll et al 25 showed that radical hysterectomy (n=169) significantly decreased the recurrence rate and improved survival with fewer disease complications compared with RT with or without chemotherapy (n=29) in stage IB1 CC. In addition, two previous SEER studies found that surgical treatment was superior to RT for stage IB–IIA CC.…”

Section: Discussionmentioning

confidence: 99%

“…To the best of our knowledge, there have been a total of five studies focusing on the survival differences between surgery and definitive RT/radiochemotherapy in patients with early-stage CC in the last two decades, 10 , 11 , 23 – 25 and the optimal local treatment modality in these patients remains controversial. A randomized study by Landoni et al 13 found equal survival rates between radical surgery and RT for stage IB–IIA cervical SCC.…”

Section: Discussionmentioning

confidence: 99%

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Comparison of survival outcomes between radical hysterectomy and definitive radiochemotherapy in stage IB1 and IIA1 cervical cancer

Zhang

et al. 2017

CMAR

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IntroductionThere is an ongoing debate regarding the optimal local treatment modalities for stage IB1 and IIA1 cervical cancer. The aim of this study was to determine whether radical hysterectomy or definitive radiochemotherapy is superior in stage IB1 and IIA1 cervical squamous cell carcinoma (SCC).MethodsFrom 1990 to 2010, a total of 3,769 patients with stage IB1 and IIA1 cervical SCC were included from the Surveillance, Epidemiology, and End Results database and were stratified according to whether they received radical hysterectomy or primary radiochemotherapy. Propensity score-matching (PSM) methods were used to balance patient baseline characteristics. Cancer-specific survival (CSS) and overall survival (OS) were compared between the two groups.ResultsOf the 3,769 patients, 3,653 (96.9%) and 116 (3.1%) patients received radical hysterectomy and definitive radiochemotherapy, respectively. Radiochemotherapy was rarely used for definitive treatment prior to 2000. Before PSM, patients who were older, of black ethnicity, and with larger tumor size and stage IIA1 disease were more likely to receive definitive radiochemotherapy. A total of 116 pairs were completely matched using PSM. The local treatment modalities had no effect on CSS or OS in either unmatched or matched populations. In the matched population, the 8-year CSS rates were 82.1% and 76.5% in surgery and radiochemotherapy groups, respectively (p=0.382). The 8-year OS rates were 74.6% and 67.8% in surgery and radiochemotherapy groups, respectively (p=0.205).ConclusionOur population-based study suggests that there is no clear local treatment of choice on survival outcomes between radical hysterectomy and definitive radiochemotherapy in patients with stage IB1 and IIA1 cervical SCC.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Comparison of survival outcomes between radical hysterectomy and definitive radiochemotherapy in stage IB1 and IIA1 cervical cancer

Zhang

et al. 2017

CMAR

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“…Previous 2 studies considered respectively 152 women with stage IA to IIB neoplasia treated by radical surgery (115) or RT (37) and 198 stage patients with IB1 cancer treated by radical surgery (169) or primary by radiation therapy respectively (29) [ 4 5 ]. Five-year cancer-specific survival rates after primary surgery and after RT were comparable for the former (80% vs. 82%, respectively), whereas they were significantly different for the latter (95% and 70%, respectively).…”

Section: Discussionmentioning

confidence: 99%

“…Yamashita et al [ 4 ] admitted that RT was preferred over surgery to treat elderly patients or women who were not medically fit to receive a surgical treatment. Doll et al [ 5 ] as well stated that their patients in the radiation group were older (median age 47 years vs. 39 years, p=0.001), and had larger tumors (mean 3.0 cm vs. 1.5 cm, p=0.002). Similarly, in 2 larger studies analyzing SEER database the survival gain assigned to the surgical treatment seems to derive from an uneven selection of patients, since primary surgery was decided on the basis of the tumor diameter.…”

Section: Discussionmentioning

confidence: 99%

“…Our randomized trial performed between 1986 and 1991 in 343 patients confirmed such statements [ 1 ]. Nonetheless there is still an ongoing debate regarding the optimal treatment for these patients, since in the last decade at least 4 non-randomized studies were published, of which 3 seem to observe a significant survival advantage for surgical treatment compared to RT ( Table 1 ) [ 2 3 4 5 ].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2017

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ObjectiveStage 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.MethodsBetween 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.ResultsThree-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).ConclusionThe 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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Type II or type III radical hysterectomy compared to chemoradiotherapy as a primary intervention for stage IB2 cervical cancer

Nama

Murdoch

Bailey

2018

Cochrane Database of Systematic Reviews

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Treatment of stage IB1 cervix cancer: Comparison of radical hysterectomy and radiation

Cited by 7 publications

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Comparison of survival outcomes between radical hysterectomy and definitive radiochemotherapy in stage IB1 and IIA1 cervical cancer

Comparison of survival outcomes between radical hysterectomy and definitive radiochemotherapy in stage IB1 and IIA1 cervical cancer

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

Type II or type III radical hysterectomy compared to chemoradiotherapy as a primary intervention for stage IB2 cervical cancer

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