[Operation or irradiation of cervix carcinoma?]

Treatment of early invasive carcinoma of the uterine cervix by radical surgery or radiation continues to engender controversy after many decades of effective therapy. A recently published first prospective randomised trial revealed that stage I and IIa cervical carcinoma can be cured by radical surgery or radiotherapy with an identical 5-year survival (83% in both groups) and a similar recurrence rate (25 vs. 26%). In many points, a prospective Italian study confirms the retrospective results of our previous published studies. Surgery and radiotherapy alone are equally effective but differ in associated complications. Severe morbidity occurred in the Italian study after surgery and radiotherapy alone in 28 and 12%, respectively (p < 0.0004). In our retrospective study, severe complications were found with surgery and adjuvant radiation in 36.4%, with radiotherapy alone in 13.7% (p < 0.001). The usefulness of postoperative radiation is not clear, and patients should not be subjected to both therapies. Optimum candidates for primary radical surgery are women with normal ovarian function and cervical diameters of 4 cm or smaller. Adenocarcinomas of the uterine cervix are better treated with surgery (5-year survival 66 vs. 47%, p < 0.02).