Intervention Review

Primary surgery versus primary radiotherapy with or without chemotherapy for early adenocarcinoma of the uterine cervix

  1. Astrid Baalbergen1,*,
  2. Yerney Veenstra1,
  3. Lukas Stalpers2

Editorial Group: Cochrane Gynaecological Cancer Group

Published Online: 31 JAN 2013

Assessed as up-to-date: 22 JUN 2012

DOI: 10.1002/14651858.CD006248.pub3


How to Cite

Baalbergen A, Veenstra Y, Stalpers L. Primary surgery versus primary radiotherapy with or without chemotherapy for early adenocarcinoma of the uterine cervix. Cochrane Database of Systematic Reviews 2013, Issue 1. Art. No.: CD006248. DOI: 10.1002/14651858.CD006248.pub3.

Author Information

  1. 1

    Reinier de Graaf Groep, Department of Obstetrics and Gynaecology, Delft, Netherlands

  2. 2

    University of Amsterdam, Department of Radiotherapy, Amsterdam, Netherlands

*Astrid Baalbergen, Department of Obstetrics and Gynaecology, Reinier de Graaf Groep, Postbus 5011, Delft, 2600 GA, Netherlands. abaalbergen@me.com.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 31 JAN 2013

SEARCH

 

Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary

Background

For early squamous cell carcinoma of the uterine cervix, the outcome is similar after either primary surgery or primary radiotherapy. There are reports that this is not the case for early adenocarcinoma (AC) of the uterine cervix: some studies have reported that the outcome is better after primary surgery. There are no systematic reviews about surgery versus chemoradiation in the treatment of cervical cancer. This is an updated version of the original Cochrane review published in Cochrane Database of Systematic Reviews 2006, Issue 4. Art. No.: CD006248. DOI: 10.1002/14651858.CD006248.

Objectives

The objectives of this review were to compare the effectiveness and safety of primary surgery for early stage AC of the uterine cervix with primary radiotherapy or chemoradiation.

Search methods

We searched Cochrane Central Register of Controlled Trials (CENTRAL) Issue 3, 2009, MEDLINE (1950 to July week 5, 2009), EMBASE (1980 to week 32, 2009) and we also searched the related articles feature of PubMed and the Web of Science. We also checked the reference lists of articles. For this update, the searches were re-run in June 2012: MEDLINE 2009 to June week 2, 2012, EMBASE 2009 to 2012 week 24, CENTRAL Issue 6, 2012, Cochrane Gynaecological Specialised Register June 2012.

Selection criteria

Studies of treatment of patients with early AC of the uterine cervix were included. Treatment included surgery, surgery followed by radiotherapy, radiotherapy and chemoradiation.

Data collection and analysis

Forty-three studies were selected by the search strategy and 30 studies were excluded. Twelve studies were considered for inclusion. Except for one randomised controlled trial (RCT), all other studies were retrospective cohort studies with variable methodological quality and had limitations of a retrospective study. Comparing the results from these retrospective studies was not possible due to diverging treatment strategies.

Main results

Analysis of a subgroup of one RCT showed that surgery for early cervical AC was better than radiotherapy. However, the majority of operated patients required adjuvant radiotherapy, which is associated with greater morbidity. Furthermore, the radiotherapy in this study was not optimal, and surgery was not compared to chemoradiation, which is currently recommended in most centres. Finally, modern imaging techniques (i.e. magnetic resonance imaging (MRI) and positive emission tomography - computed tomography (PET-CT) scanning) allow better selection of patients and node-negative patients can now be more easily identified for surgery, thereby reducing the risk of 'double trouble' caused by surgery and adjuvant radiotherapy.  

Authors' conclusions

We recommend surgery for early-stage AC of the uterine cervix in carefully staged patients. Primary chemoradiation remains a second best alternative for patients unfit for surgery; chemoradiation is probably first choice in patients with (MRI or PET-CT-suspected) positive lymph nodes. Since the last version of this review no new studies were found.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary

Surgery or radiotherapy for early cervical cancer of the adenocarcinoma type

Early-stage cervical cancer of the common type, squamous cell carcinoma, has the same prognosis after primary surgery or radiotherapy. For cervical cancer of the glandular cell type (adenocarcinoma) we recommend surgery. Second best alternative for patients unfit for surgery is chemoradiation. For patients with suspected positive lymph nodes, chemoradiation is probably the first choice.