RADICAL RADIOTHERAPY VERSUS BRACHYTHERAPY PLUS SURGERY IN CARCINOMA OF THE CERVIX 2A AND 2B - LONG-TERM RESULTS FROM A RANDOMIZED STUDY 1968-1980

To investigate whether surgery or radiotherapy should be preferred in the early stages of carcinoma of the cervix a randomized study was per formed in which operable patients with small FIGO stage 2 squamous cel l 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 w as 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 disea se. The 5-, 10-, and 20-year survival in Group A was 87, 84 and 81% re spectively 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 accoun ts for the difference between Groups A and B. Young patients (<40 year s) with large tumours had a high risk of recurrent disease. Severe uri nary and gastrointestinal complications were more common in Group A, e specially among patients given postoperative radiotherapy. Lymphoedema was seen almost exclusively in Group A. Two patients in Group A and o ne in Group B died of complications to treatment. The corrected 10-yea r survival of 69.5% as achieved in the radiotherapy arm of this series is comparable to other reported studies. The high survival rate in th e operated group, despite a very high metastases rate, suggests that s urgery is applicable also in stage 2 patients.