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Radiation therapy given after surgery may reduce the risk for recurrence of cancer over the use of surgery alone in women with stage IB cancer of the cervix, according to the results of a recent U.S. study.

Cancer of the cervix, the opening of the uterus (womb) that connects the uterus to the vagina (birth canal), is a common cancer in women. Treatment options depend on the stage of disease (extent of cancer at diagnosis) and may include surgery, radiation therapy, and/or chemotherapy. Stage IB cervical cancer is characterized by cancer that is confined to the tissues of the cervix. Bulky stage IB cervical cancer consists of cancer that is confined to the cervix, but is larger than 4 cm in size. Women who have these stages of cervical cancer often undergo surgery as primary treatment. One of the most common types of surgeries performed is a radical hysterectomy, which involves the removal of the cervix, uterus, and part of the vagina. Surgical removal of the nearby lymph nodes, called a lymph node dissection or pelvic lymphadenectomy, is also done to determine whether cancer cells have spread to these lymph nodes.

After surgery, some women may still have residual disease outside the cervix in amounts so small that they cannot be detected (called micrometasases). To help prevent any potentially remaining micrometastases from growing and causing a recurrence (return) of cancer after surgery, additional therapy is sometimes administered (called adjuvant therapy). The benefit of adjuvant therapy with radiation therapy for women with bulky stage IB cervical cancer has been documented previously; however, the role of this therapy for women with smaller stage IB cervical cancer is not yet entirely clear. Researchers recently sought to determine whether the use of radiation therapy as adjuvant therapy after surgery would prove to be more effective than surgery alone for women with this type of disease.

Researchers from several U.S. medical centers assigned 277 women with stage IB cervical cancer to receive either a radical hysterectomy alone or a radical hysterectomy followed by radiation therapy. Fifteen percent of those receiving radiation therapy had a recurrence of cancer, compared with 28% of those who had surgery only. The reduction in the risk of having a cancer recurrence with radiation therapy was 47%. There were 15 deaths from cancer in those receiving radiation therapy, compared with 25 deaths from cancer in those receiving surgery alone. In terms of side effects, gastrointestinal and urinary tract infections were more severe in the radiation therapy group, and 1 woman died of treatment-related complications.

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From these findings, it appears that the use of radiation therapy after a radical hysterectomy for stage IB cervical cancer reduces the risk of recurrence and improves survival rates over the use of surgery alone. Previous clinical trials, however, have shown that a combination of chemotherapy and radiation therapy is superior to radiation therapy alone. Women who have early-stage cervical cancer may wish to talk with their doctor about the risks and benefits of receiving radiation therapy with or without chemotherapy after surgery or of participating in a clinical trial in which promising new therapies are being studied.

Gynecologic Oncology, Vol 73, No 2, pp 177-183, 1999)