Primary therapy for early-stage cervical cancer: radical hysterectomy vs radiation
Received 6 April 2009; received in revised form 18 May 2009; accepted 5 June 2009.
Objective
We compared survival for women with early-stage cervical cancer who were treated with primary radiation or radical hysterectomy.
Study Design
Patients in the Surveillance, Epidemiology, and End Results database with stage IB1-IIA cervical cancer were examined. Radical hysterectomy was compared with primary combination external-beam and brachytherapy radiation.
Results
A total of 4885 patients were identified. Multivariate analysis showed that radical hysterectomy was associated with a 59% reduction in mortality rate (hazard ratio, 0.41; 95% confidence interval [CI], 0.35–0.50). After stratification by tumor size, hysterectomy was associated with a 62% reduction in mortality rate (hazard ratio, 0.38; 95% CI, 0.30–0.48) for tumors that were <4 cm in diameter and a 49% improvement in survival (hazard ratio, 0.51; 95% CI, 0.36–0.72) for tumors that were 4-6 cm in diameter. Among women with tumors that were >6 cm in size, survival was equivalent between radical hysterectomy and radiation.
Conclusion
Our data indicate that, in women with cervical cancer lesions of <6 cm, radical hysterectomy is superior to primary radiation.
aDivision of Gynecologic Oncology, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, NY
bDepartment of Radiation Oncology, Columbia University College of Physicians and Surgeons, New York, NY
cHerbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY
dCalifornia Pacific Medical Center, San Francisco, CA
Reprints: Jason D. Wright, MD, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, 161 Fort Washington Ave., 8th Floor, New York, NY 10032
Cite this article as: Bansal N, Herzog TJ, Shaw RE, et al. Primary therapy for early-stage cervical cancer: radical hysterectomy vs radiation. Am J Obstet Gynecol 2009;201:485.e1-9.
Authorship and contribution to the article is limited to the 6 authors indicated. There was no outside funding or technical assistance with the production of this article.
ABSTRACT
Primary therapy for early-stage cervical cancer: radical hysterectomy vs radiation