Apparent improvement in survival for carcinoma of the cervix following the introduction of chemoradiation--a Will Rogers phenomenon.
The improved survival for bulky cervical cancers (> 4cm) reported with combination platinum based chemoradiation (1999) prompted a move away from surgery as these cases frequently received adjuvant radiotherapy and were exposed to the morbidity of multimodality treatment. The period pre-1999 (Group 1) was compared with post-1999 (Group 2) when chemoradiation was the preferred treatment for bulky operable cervical cancer. Significantly more cases were treated surgically among Group 1 compared with Group 2 (79% vs. 62%; P < 0.001). Switching from surgery to radiotherapy improved survival in both treatment categories (73% vs. 78% and 37% vs. 44%, respectively) but with no improvement in overall survival (70%/ov.s 70%). Survival (86%) was similar in both groups among surgically treated women with tumors < 4 cm, but significantly more in Group 2 with negative nodes received postoperative adjuvant chemoradiotherapy (Groups 1 vs. 2; 16% vs.37.5%: P < 0.001) and overall the surgically treated patients received more not less multimodality treatment (46.5% vs. 59%; P = 0.7).
Dept. of Obstetrics & Gynaecology, UCD,National Maternity Hospital, Holles St, Dublin 2. mfoley@nmh.ie
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Foley
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Ryan
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E
Kearney
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Herlihy
H
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Craig
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P
Kelehan
E
E
Mooney
P
P
Lenehan
G
G
Flannelly
D002277:Carcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D059248:Chemoradiotherapy / Q000379:methods; D059186:Chemoradiotherapy, Adjuvant / Q000379:methods; D015331:Cohort Studies; D003131:Combined Modality Therapy / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D009367:Neoplasm Staging; D016019:Survival Analysis; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery / Q000628:therapy*