title: Randomized study between radical surgery and radiotherapy for the treatment of stage IB-IIA cervical cancer: 20-year update.
abstract: OBJECTIVE
  Stage IB-IIA cervical carcinoma can be equally cured either by radical surgery or radiotherapy (RT). Albeit such policies show the same efficacy, they carry a different morbidity. This is an update after 20 years of a previously published randomized trial of RT vs. surgery in the treatment of stage IB-IIA cervical cancers to assess long-term survival and morbidity and the different pattern of relapse between the 2 modalities.
  
  
  METHODS
  Between September 1986 and December 1991, women referred for a newly diagnosed stage IB and IIA cervical carcinoma were randomized to radical surgery or RT. The primary outcome measures were long-term survival and complications rate. The secondary outcome was recurrence of the disease.
  
  
  RESULTS
  Three-hundred forty-three eligible women were randomized: 172 to radical surgery and 171 to external RT. Minimum follow-up was 19 years. Thirty-three patients (10%) died of intercurrent disease (31 cases) or fatal complications (2 cases). Twenty-year overall survival is 72% and 77% in the 2 treatment groups (p=0.280), respectively. As a whole, 94 recurrences (28%) were observed. Median time to relapse was 13.5 (surgery group) and 11.5 months (radiotherapy group) (p=0.100), respectively. Multivariate analysis confirms that risk factors for survival are histotype (p=0.020), tumor diameter (p=0.008), and lymph node status (p<0.001).
  
  
  CONCLUSIONS
  The results of the present study seem to suggest that there is no treatment of choice for early stage cervical carcinoma in terms of survival. Long term follow-up confirms that the best treatment for the individual patient should take into account clinical factors such as menopausal status, comorbidities, histological type, and tumor diameter.
authors.affiliation: Division of Gynecology, European Institute of Oncology, Milan, Italy. fabio.landoni@ieo.it.
authors.forename: Fabio
authors.identifier: http://orcid.org/0000-0001-6734-739X
authors.initials: F
authors.lastname: Landoni
authors.affiliation: Division of Radiotherapy, Hospital of Lecco, Lecco, Italy.
authors.forename: Alessandro
authors.identifier: http://orcid.org/0000-0002-8180-2413
authors.initials: A
authors.lastname: Colombo
authors.affiliation: Obstetrics and Gynecology Clinic, University of Milan-Bicocca, Monza, Italy.
authors.forename: Rodolfo
authors.identifier: http://orcid.org/0000-0003-3349-7650
authors.initials: R
authors.lastname: Milani
authors.affiliation: Division of Radiotherapy, Hospital of Lecco, Lecco, Italy.
authors.forename: Franco
authors.identifier: http://orcid.org/0000-0001-9765-0824
authors.initials: F
authors.lastname: Placa
authors.affiliation: Division of Gynecology, European Institute of Oncology, Milan, Italy.
authors.forename: Vanna
authors.identifier: http://orcid.org/0000-0002-7123-191X
authors.initials: V
authors.lastname: Zanagnolo
authors.affiliation: Obstetrics and Gynecology Clinic, University of Milan-Bicocca, Monza, Italy.
authors.forename: Costantino
authors.initials: C
authors.lastname: Mangioni
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D016009:Chi-Square Distribution; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007044:Hysterectomy; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local; D011882:Radiotherapy, High-Energy; D013997:Time Factors; D002583:Uterine Cervical Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*
keywords: Locally Advanced; Radiotherapy; Surgery; Uterine Cervical Neoplasms