A therapeutic approach to primary adenocarcinoma of the cervix

Retrospective study of 97 patients with primary adenocarcinoma of the uterine cervix was undertaken to evaluate the efficacy of two treatment methods, radiation alone and radiation plus surgery. Of 31 Stage I patients, 16 were treated with radiation alone and 15 with combined radiation plus surgery. There was no difference in 5-year disease-free survival of Stage I patients treated by either method. Of 44 Stage II patients, 30 were treated with radiation alone with 54% survival rate; while 14 were treated with a combined approach, with 86% survival rate. It is apparent from the results of this study that surgery in conjunction with radiation showed a significant improved survival rate from 54% to 86% in Stage II disease. Factors influencing the prognosis appear to be tumor volume, uterine size, and tumor grade. Furthermore, these data suggest that early primary adenocarcinoma of the cervix (Stage I, lesion smaller than 4 cm) can be treated effectively by radiation alone or radical hysterectomy with comparable results. Tumors larger than 4 cm, Stage II or beyond disease, uterine enlargement, a high-grade tumor or barrel-shaped lesion, would necessitate a combined therapy to improve the cure rate.