RADICAL SURGERY OR RADIOTHERAPY FOR CANCE R OF THE UTERINE CERVIX

Treatment of early invasive carcinoma of the uterine cervix by radical surgery or radiation continues to engender controversy after many dec ades of effective therapy. A recently published first prospective rand omised trial revealed that stage I and IIa cervical carcinoma can be c ured by radical surgery or radiotherapy with an identical 5-year survi val (83% in both groups) and a similar recurrence rate (25 vs. 26%). I n many points, a prospective Italian study confirms the retrospective results of our previous published studies. Surgery and radiotherapy al one are equally effective but differ in associated complications. Seve re morbidity occurred in the Italian study after surgery and radiother apy alone in 28 and 12%, respectively (p < 0.0004). In our retrospecti ve study, severe complications were found with surgery and adjuvant ra diation in 36.4%, with radiotherapy alone in 13.7% (p < 0.001). The us efulness of postoperative radiation is not clear, and patients should not be subjected to both therapies. Optimum candidates for primary rad ical surgery are women with normal ovarian function and cervical diame ters of 4 cm or smaller. Adenocarcinomas of the uterine cervix are bet ter treated with surgery (5-year survival 66 vs. 47%, p < 0.02).