Radical radiotherapy versus brachytherapy plus surgery in carcinoma of the cervix 2A and 2B--long-term results from a...

To investigate whether surgery or radiotherapy should be preferred in the early stages of carcinoma of the cervix a randomized study was performed in which operable patients with small FIGO stage 2 squamous cell carcinoma were included. Of these patients, 122 were in stage 2A and 20 in stage 2B. The patients were treated with intracavitary radium, followed by either radical surgery with pelvic lymphadenectomy (Group A, 72 patients) or high-voltage external irradiation 40 Gy to a pelvic field (Group B, 70 patients). Postoperative irradiation 40 to 50 Gy was given in Group A if lymph node metastases were found at operation. Fourteen patients in Group A and 23 in Group B died of recurrent disease. The 5-, 10-, and 20-year survival in Group A was 87, 84 and 81% respectively compared with 72, 69, and 68% in Group B, p < 0.05. Twenty-three (34%) of 67 radically operated patients had metastases to pelvic lymph nodes. A high rate of pelvic and para-aortic recurrences accounts for the difference between Groups A and B. Young patients (<40 years) with large tumours had a high risk of recurrent disease. Severe urinary and gastrointestinal complications were more common in Group A, especially among patients given postoperative radiotherapy. Lymphoedema was seen almost exclusively in Group A. Two patients in Group A and one in Group B died of complications to treatment. The corrected 10-year survival of 69.5% as achieved in the radiotherapy arm of this series is comparable to other reported studies. The high survival rate in the operated group, despite a very high metastases rate, suggests that surgery is applicable also in stage 2 patients.