title: Substantial improvement in UK cervical cancer survival with chemoradiotherapy: results of a Royal College of Radiologists' audit.
abstract: OBJECTIVE
  To compare survival and late complications between patients treated with chemoradiotherapy and radiotherapy for locally advanced cervix cancer.
  
  
  METHODS
  A Royal College of Radiologists' audit of patients treated with radiotherapy in UK cancer centres in 2001-2002. Survival, recurrence and late complications were assessed for patients grouped according to radical treatment received (radiotherapy, chemoradiotherapy, postoperative radiotherapy or chemoradiotherapy) and non-radical treatment. Late complication rates were assessed using the Franco-Italian glossary.
  
  
  RESULTS
  Data were analysed for 1243 patients from 42 UK centres. Overall 5-year survival was 56% (any radical treatment); 44% (radical radiotherapy); 55% (chemoradiotherapy) and 71% (surgery with postoperative radiotherapy). Overall survival at 5 years was 59% (stage IB), 44% (stage IIB) and 24% (stage IIIB) for women treated with radiotherapy, and 65% (stage IB), 61% (stage IIB) and 44% (stage IIIB) for those receiving chemoradiotherapy. Cox regression showed that survival was significantly better for patients receiving chemoradiotherapy (hazard ratio=0.77, 95% confidence interval 0.60-0.98; P=0.037) compared with those receiving radiotherapy taking age, stage, pelvic node involvement and treatment delay into account. The grade 3/4 late complication rate was 8% (radiotherapy) and 10% (chemoradiotherapy). Although complications continued to develop up to 7 years after treatment for those receiving chemoradiotherapy, there was no apparent increase in overall late complications compared with radiotherapy alone when other factors were taken into account (hazard ratio=0.94, 95% confidence interval 0.71-1.245; P=0.667).
  
  
  CONCLUSIONS
  The addition of chemotherapy to radiotherapy seems to have improved survival compared with radiotherapy alone for women treated in 2001-2002, without an apparent rise in late treatment complications.
authors.affiliation: Meta-analysis Group, MRC Clinical Trials Unit, London, UK.
authors.forename: C L
authors.initials: CL
authors.lastname: Vale
authors.forename: J F
authors.initials: JF
authors.lastname: Tierney
authors.forename: S E
authors.initials: SE
authors.lastname: Davidson
authors.forename: K J
authors.initials: KJ
authors.lastname: Drinkwater
authors.forename: P
authors.initials: P
authors.lastname: Symonds
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001859:Bone Neoplasms / Q000401:mortality / Q000556:secondary / Q000628:therapy; D001918:Brachytherapy; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000556:secondary / Q000628:therapy; D008175:Lung Neoplasms / Q000401:mortality / Q000556:secondary / Q000628:therapy; D008207:Lymphatic Metastasis; D008485:Medical Audit; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D009367:Neoplasm Staging; D010386:Pelvic Neoplasms / Q000209:etiology / Q000473:pathology; D018787:Radiation Oncology; D011879:Radiotherapy Dosage; D015996:Survival Rate; D017741:Survivors; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D055815:Young Adult