Patients with stage IB or IIA cervical cancer have disease that is confined to the cervix or cancer that has spread to an area adjacent to the cervix referred to as the parametria. These patients have historically been treated with surgical hysterectomy or radiation therapy. Some physicians favored surgical treatment and others favored radiation therapy. It is unclear whether one therapy is superior to the other, however, each therapy is associated with a different range of side effects.
In order to evaluate the role of surgical and radiation treatment for stage IB-IIA cervical cancer, doctors in Italy performed a clinical trial that directly compared these 2 treatments. In this clinical study, 172 patients were treated with surgery and 171 with radiation therapy. Patients treated with radiation therapy received external pelvical radiation and implant radiation. Patients treated with surgery underwent an abdominal hysterectomy and evaluation of the pelvic lymph nodes. Patients treated with surgery who were found to have cancer in the lymph nodes or more invasive cancer were additionally treated with external pelvic radiation therapy over a period of 5 to 6 weeks.
After an average follow-up of over 7 years, there is no difference in the overall survival rates between patients treated with surgery or those treated with radiation therapy. Five-year survival rate is approximately 83% and the probability of being without evidence of cancer 5 years from treatment is approximately 74%. Patients treated with surgery were more likely to experience significant side effects of treatment compared to patients treated with radiation therapy. In all, 28% of patients treated with surgery experienced significant side effects compared to only 12% of patients treated with radiation.
Over half of the patients treated with radical hysterectomy ultimately also required a course of external beam radiation therapy. In patients receiving both surgery and external beam radiation therapy, side effects were more frequent than patients treated with surgery or radiation therapy alone.
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In summary, both surgical hysterectomy and radiation therapy produce equivalent survival and cure rates for patients with stage IB and IIA carcinoma of the cervix. Patients treated with a strategy of surgery are more likely to experience more significant side effects than patients treated with radiation. Moreover, approximately half the patients treated with surgery ultimately are treated with a course of radiation therapy. The combination of surgery and radiation therapy is associated with the highest degree of side effect. Patients will need to wave the risks and the benefits of adopting a surgical or radiation treatment strategy following discussion with their treating physician. (Lancet, Vol 350, 1997)