Source: DGNews  |  Posted 1 year ago

By Fred Gebhart

SAN FRANCISCO -- March 20, 2010 -- A retrospective analysis suggests a change in treatment for women with stage IB2 cervical carcinoma. The majority of women have radiation, then surgery, but treatment and outcomes from the Surveillance, Epidemiology and End Results (SEER) database point to increased survival for women who have surgery followed by radiation.

“We have seen treatment for women with stage IB2 cervical cancer shift from primary surgery to primary radiation,” said Madeline Courtney-Brooks, Magee-Womens Hospital, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, here on March 16 at the Society of Gynecologic Oncologists (SGO) 41st Annual Meeting on Women’s Cancer.

“But the data show that primary surgery is more effective both in terms of disease-specific survival and overall survival than primary radiation.”

Chemoradiation has been emphasised in the treatment of invasive cervical cancer for the past decade, according to Dr. Courtney-Brooks. Stage IB2 cervical cancer is generally treated either by surgery followed by adjuvant therapy based on risk factors are with chemoradiation.

There are no randomised trials comparing these 2 strategies, although the Gynecology Oncology Group (GOG) tried, and failed, to accrue sufficient patients in GOG-201. When GOG-201 was closed, University of Pittsburgh researchers turned to the SEER database for a retrospective study.

The group identified 780 patients treated with radiation and/or surgery for stage IB2 cervical cancer between 2000 and 2006. Patients were stratified by the initial treatment: 267 who received radiation first and 513 who received surgery first. There was no difference in mean tumour size between the 2 groups, although the radiation-first group was older (49 vs 46 y) in the surgery-first group (P < .01). African Americans were more likely to receive radiation first compared with Caucasians (58.6% vs 34.2%; P < .01).

Surgery was the predominant first choice of treatment in the early years of the study, ranging from 62.6% of patients in 2000 to 53.4% in 2003. Treatment preferences shifted in 2004, with radiation the first choice of treatment for 55.4% of women and increasing slightly to 55.3% in 2006.

There was no corresponding change in survival. Overall 5-year survival favoured surgery first, 79.1% compared with 60% for radiation first (P < .001). Patients in the surgery-first group had a 7.5-month disease-specific survival advantage (P < .001). The disease-specific and overall survival advantages held true irrespective of age at diagnosis, race, or tumour size.

Patients undergoing surgery first appear to have a treatment advantage, Dr. Courtney-Brooks said, although at least part of the effect may be due to selection bias. Patients in the radiation group may be subject to more comorbidities such as obesity or older age which are not apparent from SEER data.

“Surgery may be the more likely first choice for healthier patients,” she said, “but it is impossible to determine from SEER. These results emphasise the need for randomised controlled trials. It is difficult to draw definitive conclusions from retrospective data.”

[Presentation title: Surgery Versus Radiation Therapy for Stage IB2 Cervical Carcinoma: A Population-Based Outcome Analysis in the Era of Chemoradiation. Abstract 48]