RADICAL HYSTERECTOMY FOR EARLY CERVICAL CANCER

NEW YORK (Reuters Health) Nov 27 - For women with early-stage cervical cancer, outcomes and survival are better with surgery than with radiation treatment, according to researchers. However, the advantage is limited to women with tumors 6 cm in size or less.

Dr. Jason D. Wright, of Columbia University College of Physicians and Surgeons, New York, and colleagues used data from the Surveillance, Epidemiology, and End Results database to compare survival for women with early-stage (stage IB1-IIA) cervical cancer who were treated with primary radiation or radical hysterectomy.

Of 4885 patients identified, 4012 women (82.1%) underwent radical hysterectomy and 873 (17.9%) underwent primary radiotherapy.

Cox proportional hazards analysis demonstrated an association between radical hysterectomy and a 59% reduction in cancer-specific mortality, a report in the November issue of the American Journal of Obstetrics and Gynecology indicates.

Adding adjuvant radiation to primary hysterectomy reduced overall mortality by 52%, the report shows.

Multivariate analysis showed that after stratification by tumor size, radical hysterectomy was associated with a 62% reduction in mortality for women with tumors of less than 4 cm compared with radiotherapy. For those with tumors of 4 to 6 cm, hysterectomy was associated with a 49% reduction in mortality rate. By contrast, survival was similar for radical hysterectomy and radiation among women with tumors that were greater than 6 cm.

"Patients and physicians should strongly consider primary surgery for patients with early-stage cervical cancer," Dr. Wright told Reuters Health.

"The decision on the best treatment for early-stage cervical cancer is often complex and involves patient preferences, cancer characteristics, and consideration of a patient's underlying medical problems," he explained. "Our findings must be placed in the context of these factors, but the survival advantage we noted should also influence treatment planning."

Am J Obstet Gynecol 2009;201:485e1-9.