Substantial Improvement in UK Cervical Cancer Survival with Chemoradiotherapy: Results of a Royal College of Radiologists’ Audit
Received 21 January 2010; received in revised form 7 April 2010; accepted 26 April 2010. published online 01 July 2010.
Abstract
Aims
To compare survival and late complications between patients treated with chemoradiotherapy and radiotherapy for locally advanced cervix cancer.
Materials and methods
A Royal College of Radiologists’ audit of patients treated with radiotherapy in UK cancer centres in 2001–2002. Survival, recurrence and late complications were assessed for patients grouped according to radical treatment received (radiotherapy, chemoradiotherapy, postoperative radiotherapy or chemoradiotherapy) and non-radical treatment. Late complication rates were assessed using the Franco-Italian glossary.
Results
Data were analysed for 1243 patients from 42 UK centres. Overall 5-year survival was 56% (any radical treatment); 44% (radical radiotherapy); 55% (chemoradiotherapy) and 71% (surgery with postoperative radiotherapy). Overall survival at 5 years was 59% (stage IB), 44% (stage IIB) and 24% (stage IIIB) for women treated with radiotherapy, and 65% (stage IB), 61% (stage IIB) and 44% (stage IIIB) for those receiving chemoradiotherapy. Cox regression showed that survival was significantly better for patients receiving chemoradiotherapy (hazard ratio=0.77, 95% confidence interval 0.60–0.98; P=0.037) compared with those receiving radiotherapy taking age, stage, pelvic node involvement and treatment delay into account. The grade 3/4 late complication rate was 8% (radiotherapy) and 10% (chemoradiotherapy). Although complications continued to develop up to 7 years after treatment for those receiving chemoradiotherapy, there was no apparent increase in overall late complications compared with radiotherapy alone when other factors were taken into account (hazard ratio=0.94, 95% confidence interval 0.71–1.245; P=0.667).
Discussion
The addition of chemotherapy to radiotherapy seems to have improved survival compared with radiotherapy alone for women treated in 2001–2002, without an apparent rise in late treatment complications.
§Department of Cancer Studies & Molecular Medicine, University of Leicester, Leicester Royal Infirmary, Leicester, UK
Author for correspondence: P. Symonds, Department of Cancer Studies & Molecular Medicine, Level 2, Osborne Building, Leicester Royal Infirmary, Leicester LE1 5WW, UK. Tel: +44-116-258-6294; Fax: +44-116-258-7599.
ABSTRACT