Intent-to-treat analysis of stage Ib and IIa cervical cancer in the UnitedStates: Radiotherapy or surgery 1988-1995

Objective: To estimate the patterns of care and outcome of women with early cervical cancer in the United States based on surgical or radiation intent -to-treat principles. Methods: The Surveillance, Epidemiology, and End Results 1995 public-use fi le was the data source. Subjects between the ages of 15 and 80 years at dia gnosis who were treated for stage Ib or IIa cervical cancer were identified . The 1039 women who comprised the study group were stratified according to age at diagnosis (40 years or less, older than 40 years), primary treatmen t intent (surgery, radiotherapy), tumor size (4 cm or less, over 4 cm), reg istry site, and ethnicity. Survival analyses included 784 women who had at least 2 years of follow-up. Results: There were 276 cancers (26.5%) over 4 cm, and 586 (56%) women were older than 40 years at diagnosis. There were 741 (71%) subjects in the sur gical intent-to-treat group, and the remainder (298) were in the radiation intent-to-treat group. Kaplan-Meier analysis indicated a 5-year survival ad vantage for women with tumors 4 cm or less who were in the surgical intent- to-treat group compared with the radiation intent-to-treat group (86% and 7 1%, P < .001). Treatment group was not prognostic for cervical cancers over 4 cm (surgical intent-to-treat compared with radiation intent-to-treat; 72 % and 68% survival, respectively). Multivariable analysis confirmed a survi val advantage for women with surgical intent-to-treat and tumors of 4 cm or less. Conclusion: In the United States there is a survival advantage for surgical intent-to-treat compared with radiation intent-to-treat for women with tum ors 4 cm or less, independent of ethnicity, adjuvant therapy, or age. (Obst et Gynecol 2001;97:248-54. (C) 2001 by The American College of Obstetrician s and Gynecologists.).