Radical hysterectomy compared with primary radiation for treatment of stage IB1 cervix cancer Journal Article

Authors: Doll, K. M.; Donnelly, E; Helenowski, I; Rosenbloom, L.; Small, W., Jr; Schink, J. C.; Lurain, J. R.
Article Title: Radical hysterectomy compared with primary radiation for treatment of stage IB1 cervix cancer
Abstract: OBJECTIVE: We reviewed data on treatment of stage IB1 cervical cancer at our institution to compare recurrence, complications, and survival of women treated primarily by radical hysterectomy versus radiation. METHODS: Records for women treated for stage IB1 cervical cancer between January 1, 1990 and June 1, 2010 were retrospectively reviewed. Recurrence, survival outcomes, and complications were examined and compared. Demographic, clinical, and histopathologic factors were also analyzed. RESULTS: Of 198 patients with stage IB1 cervix cancer, 169 (85%) underwent radical hysterectomy, including 37 (20%) who received postoperative radiation, and 29 (15%) were treated primarily with radiotherapy+/-chemotherapy. Progression-free survival, overall survival, and disease-specific survival were all longer in the surgery group (89%, 95%, and 96%) versus the radiation group (70%, 70%, and 78%), respectively (P0.001). Patients in the radiation group were older, had larger tumors, and were more likely to have medical comorbidities than patients in the surgery group. Within the surgical cohort, lymphvascular space invasion, outer third cervical stromal invasion, positive surgical margins, and lymph node metastasis were all predictive of recurrence (P0.002), whereas histopathology, smoking, diabetes, and immunosuppression were not. Grade 3 or 4 complication rates were higher among the 29 patients who had primary radiotherapy (20.7%) and the 37 patients who had surgery followed by radiotherapy (21.6%) compared with the 132 patients who had surgery only (9.1%) (P=0.047). CONCLUSIONS: Primary treatment of stage IB1 cervix cancer with radical hysterectomy+/-adjuvant radiation resulted in a significantly lower rate of recurrence and an improved survival with fewer complications compared with radiotherapy with or without chemotherapy.
Keywords: Adult; Aged; Female; Humans; Middle Aged; Male; Retrospective Studies; Disease-Free Survival; Radiation Oncology; Neoplasm Staging; Kaplan-Meier Estimate; Neoplasm Invasiveness; Chemotherapy, Adjuvant; Hysterectomy/adverse effects/methods; Illinois/epidemiology; Lymph Node Excision; Lymphatic Metastasis; Medical Records; Neoplasm Recurrence, Local/diagnosis/epidemiology; Patient Selection; Radiotherapy, Adjuvant; Selection Bias; Uterine Cervical Neoplasms/epidemiology/pathology/radiotherapy/surgery
Journal Title: American journal of clinical oncology
Volume: 37
Issue: 1
ISSN: 1537-453X; 0277-3732
Publisher: Unknown  
Journal Place: United States
Date Published: 2014
Start Page: 30
End Page: 34
Language: eng
Notes: JID: 8207754; ppublish