A retrospective review of patients with stage IB2 cervical cancer treated with radical radiation versus radical surgery as a primary modality

Objective: To review the efficacy of treatment modalities in patients with stage IB2 cervical cancer treated at Groote Schuur Hospital, Cape Town, South Africa. Materials and Methods: This was a retrospective observational study of patients with stage IB2 cervical cancer treated from 1993 to 2008 with either primary radiotherapy, (with or without follow-on hysterectomy) or primary surgery (with or without adjuvant radiotherapy). Weekly cisplatin given concurrently with radiotherapy was used since 2003. Patient outcomes and grade 3 to grade 4 treatment-related toxicities were recorded. Results: The study included 78 eligible patients for whom the 5-year overall survival rate was 70.8%. Overall 5-year survival rate by treatment modality was 88% for the 25 patients in the surgery group and 62.5%for the 53 patients in the radiotherapy group. Therewas a marked difference in the proportion of patients in each group receiving additional therapy: 88% of patients in the primary surgery group had adjuvant radiotherapy, whereas only 5.7% of patients in the primary radiotherapy group went on to have a hysterectomy. Grade 3 to grade 4 toxicity was found in 13.2% of the radiotherapy group versus 4% of the surgery group (P = 0.4). Conclusion: The optimal primary treatment for stage IB2 cervical cancer remains unclear. Both types of primary treatments were found to be feasible therapeutic approaches. Primary surgery seems to have better survival outcomes at our institution. Selection bias including a larger median tumor size in the radiotherapy group and inadequate concurrent chemotherapy (≤3 cycles) in 58% of the patients receiving primary radiotherapy probably accounted for the difference in survival. Thus, primary concurrent chemoradiation is being increasingly used for these patients at our institution in an effort to decrease bimodal treatment and limit the potential for increased toxicity and treatment costs. Evidence from a randomized controlled study is needed to determine the optimal treatment for stage IB2 cervical cancer. Copyright © 2013 by IGCS and ESGO.