Analysis of Treatment Outcomes According to Treatment Modalities for Patients with Stage IB-IIA Cervical Cancer

Abstract

The most optimal primary treatment for early stage cervical cancer remains unclear because both radiotherapy (RT) and surgery are feasible therapeutic approaches. Since the only randomized study was performed many years ago and retrospective studies report diverse results, our aim in this study was to analyze the treatment outcomes and toxicity in FIGO IB-IIA stage cervical cancer patients depending on the primary treatment they received. Furthermore, we wanted to investigate whether there would be a subgroup in the low risk group in need of adjuvant treatment after surgery. A total of 334 patients diagnosed with histologically proven FIGO stage IB to IIA cervical cancer who were treated with a curative aim between September 2001 and June 2013 were analyzed. Patients were divided into three groups according to the treatment modality received: RT group (n = 88), surgery group (n = 129), and surgery + RT group (n = 117). Treatment outcomes and late toxicity were retrospectively analyzed. The median follow-up period was 77.5 months (range, 3.1 – 188.1 months). In the RT group, patients were older, had more medical comorbidities and had more tumors larger than 4cm. The surgery group consisted mostly of patients with stage IB disease and no lymph node metastasis. The 5-year overall survival rates were 82.8%, 96.9%, and 86.0%, for RT, surgery, and surgery + RT groups, respectively. For recurrence-free rates, including all local, regional, and distant failures, there were no differences between the three groups. The most frequent patterns of failure were distant failure for the RT and surgery + RT groups and local and regional failures for the surgery group. Among those who received surgery, low risk patients who did not meet the Sedlis criteria were further analyzed and patients with 0 risk factors showed excellent results whereas patients with one or two risk factors showed locoregional failures. Severe late toxicity rates were 6.8%, 6.2% and 6.0% for RT group, surgery group and surgery + RT group, respectively. Despite the drawback from retrospective analysis, this study demonstrated that RT improved locoregional control in both definitive and adjuvant settings compared with surgery alone. Further meticulous risk stratification is needed to select the patients who could benefit from adjuvant RT.