Apparent improvement in survival for carcinoma of the cervix following the introduction of chemoradiation--a will Rogers phenomenon
Foley, M.E.; Ryan, H.; Kearney, E.; Herlihy, A.; Craig, H.; Kelehan, P.; Mooney, E.; Lenehan, P.; Flannelly, G.
Irish Medical Journal 106(3): 74-77
2013
ISSN/ISBN: 0332-3102 PMID: 23951975 Document Number: 666102
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).