Primary therapy for early-stage cervical cancer: radical hysterectomy vs radiation

Objective: We compared survival for women with early-stage cervical cancer who were treated with primary radiation or radical hysterectomy. Study Design: Patients in the Surveillance, Epidemiology, and End Results database with stage IB1-IIA cervical cancer were examined. Radical hysterectomy was compared with primary combination external-beam and brachytherapy radiation. Results: A total of 4885 patients were identified. Multivariate analysis showed that radical hysterectomy was associated with a 59% reduction in mortality rate (hazard ratio, 0.41; 95% confidence interval [CI], 0.35-0.50). After stratification by tumor size, hysterectomy was associated with a 62% reduction in mortality rate (hazard ratio, 0.38; 95% CI, 0.30-0.48) for tumors that were <4 cm in diameter and a 49% improvement in survival (hazard ratio, 0.51; 95% CI, 0.36-0.72) for tumors that were 4-6 cm in diameter. Among women with tumors that were >6 cm in size, survival was equivalent between radical hysterectomy and radiation. Conclusion: Our data indicate that, in women with cervical cancer lesions of <6 cm, radical hysterectomy is superior to primary radiation.