Concurrent chemotherapy and pelvic radiation therapy compared with pelvic radiation therapy alone as adjuvant therapy after radical surgery in high-risk early-stage cancer of the cervix. Randomised study of radical surgery versus radiotherapy for stage Ib-IIa cervical cancer Radical hysterectomy or radiotherapy for stage I cervical cancer. A prospective comparison with 5 and 10 years follow-up. Concurrent cisplatin-based radiotherapy and chemotherapy for locally advanced cervical cancer. Radiotherapy and surgery in the management of stage IB and IIA carcinoma of the cervix. Cisplatin, radiation, and adjuvant hysterectomy compared with radiation and adjuvant hysterectomy for bulky stage IB cervical carcinoma. Radical radiotherapy versus brachytherapy plus surgery in carcinoma of the cervix 2A and 2B--long-term results from a randomized study 1968-1980. Randomized comparison of fluorouracil plus cisplatin versus hydroxyurea as an adjunct to radiation therapy in stage IIB-IVA carcinoma of the cervix with negative para-aortic lymph nodes: a Gynecologic Oncology Group and Southwest Oncology Group study. An analysis of cell type in patients with surgically staged stage IB carcinoma of the cervix: a Gynecologic Oncology Group study. Prognostic factors of primary adenocarcinoma of the uterine cervix. Stage IIB-IVB cervical adenocarcinoma: prognostic factors and survival. Treatment of cervical cancer. A randomized study of operation and radiation. Pelvic radiation with concurrent chemotherapy compared with pelvic and para-aortic radiation for high-risk cervical cancer. Irradiation alone or combined with surgery in stage IB, IIA, and IIB carcinoma of uterine cervix: update of a nonrandomized comparison. Publication bias in clinical research
PURPOSE To determine whether the addition of cisplatin-based chemotherapy ( CT ) to pelvic radiation therapy ( RT ) will improve the survival of early-stage , high-risk patients with cervical carcinoma . PATIENTS AND METHODS Patients with clinical stage IA(2 ) , IB , and IIA carcinoma of the cervix , initially treated with radical hysterectomy and pelvic lymphadenectomy , and who had positive pelvic lymph nodes and /or positive margins and /or microscopic involvement of the parametrium were eligible for this study . Patients were r and omized to receive RT or RT + CT . Patients in each group received 49.3 GY RT in 29 fractions to a st and ard pelvic field . Chemotherapy consisted of bolus cisplatin 70 mg/m(2 ) and a 96-hour infusion of fluorouracil 1,000 mg/m(2)/d every 3 weeks for four cycles , with the first and second cycles given concurrent to RT . RESULTS Between 1991 and 1996 , 268 patients were entered onto the study . Two hundred forty-three patients were assessable ( 127 RT + CT patients and 116 RT patients ) .  Progression-free and overall survival are significantly improved in the patients receiving CT . The hazard ratios for progression-free survival and overall survival in the RT only arm versus the RT + CT arm are 2.01 ( P = .003 ) and 1.96 ( P = . 007 ) , respectively . The projected progression-free survivals at 4 years is 63 % with RT and 80 % with RT + CT . The projected overall survival rate at 4 years is 71 % with RT and 81 % with RT + CT . Grade s 3 and 4 hematologic and gastrointestinal toxicity were more frequent in the RT + CT group . CONCLUSION The addition of concurrent cisplatin-based CT to RT significantly improves progression-free and overall survival for high-risk , early-stage patients who undergo radical hysterectomy and pelvic lymphadenectomy for carcinoma of the cervix BACKGROUND Stage Ib and IIa cervical carcinoma can be cured by radical surgery or radiotherapy . These two procedures are equally effective , but differ in associated morbidity and type of complications . In this prospect i ve r and omised trial of radiotherapy versus surgery , our aim was to assess the 5-year survival and the rate and pattern of complications and recurrences associated with each treatment . METHODS Between September , 1986 , and December , 1991 , 469 women with newly diagnosed stage Ib and IIa cervical carcinoma were referred to our institute . 343 eligible patients were r and omised : 172 to surgery and 171 to radical radiotherapy . Adjuvant radiotherapy was delivered after surgery for women with surgical stage pT2b or greater , less than 3 mm of safe cervical stroma , cut-through , or positive nodes . The primary outcome measures were 5-year survival and the rate of complications . The analysis of survival and recurrence was by intention to treat and analysis of complications was by treatment delivered . FINDINGS 170 patients in the surgery group and 167 in the radiotherapy group were included in the intention-to-treat analysis ; scheduled treatment was delivered to 169 and 158 women , respectively , 62 of 114 women with cervical diameters of 4 cm or smaller and 46 of 55 with diameters larger than 4 cm received adjuvant therapy . After a median follow-up of 87 ( range 57 - 120 ) months , 5-year overall and disease-free survival were identical in the surgery and radiotherapy groups ( 83 % and 74 % , respectively , for both groups ) , 86 women developed recurrent disease : 42 ( 25 % ) in the surgery group and 44 ( 26 % ) in the radiotherapy group . Significant factors for survival in univariate and multivariate analyses were : cervical diameter , positive lymphangiography , and adeno-carcinomatous histotype . 48 ( 28 % ) surgery-group patients had severe morbidity compared with 19 ( 12 % ) radiotherapy-group patients ( p = 0.0004 ) . INTERPRETATION There is no treatment of choice for early-stage cervical carcinoma in terms of overall or disease-free survival . The combination of surgery and radiotherapy has the worst morbidity , especially urological complications . The optimum therapy for each patient should take account of clinical factors such as menopausal status , age , medical illness , histological type , and cervical diameter to yield the best cure with minimum complications A prospect i ve study of the treatment of 119 patients with Stage I carcinoma of the cervix by radical hysterectomy alone ( 58 patients ) or radiotherapy alone ( 61 patients ) was undertaken between Jan. 1 , 1956 , and May 31 , 1966 . Eighty-one per cent of the patients treated by radical hysterectomy  survived 5 years as compared with 74 per cent of those treated by radiotherapy . The 10 year survival rates were 75 and 65 per cent , respectively . These differences were not statistically significant . Complications of treatment were relatively few except for a greater incidence of urinary tract problems after surgical treatment ; most of these were resolved with restoration of normal function . When recurrence occurred in the surgical series further treatment by radiotherapy offered a reasonable prospect of survival . Failure of radiotherapy  left relatively little opportunity for later treatment by operation BACKGROUND AND METHODS On behalf of the Gynecologic Oncology Group , we performed a r and omized trial of radiotherapy in combination with three concurrent chemotherapy regimens -- cisplatin alone ; cisplatin , fluorouracil , and hydroxyurea ; and hydroxyurea alone -- in patients with locally advanced cervical cancer . Women with primary untreated invasive squamous-cell carcinoma , adenosquamous carcinoma , or adenocarcinoma of the cervix of stage IIB , III , or IVA , without involvement of the para-aortic lymph nodes , were enrolled . The patients had to have a leukocyte count of at least 3000 per cubic millimeter , a platelet count of at least 100,000 per cubic millimeter , a serum creatinine level no higher than 2 mg per deciliter ( 177 micromol per liter ) , and adequate hepatic function . All patients received external-beam radiotherapy according to a strict protocol . Patients were r and omly assigned to receive one of three chemotherapy regimens : 40 mg of cisplatin per square meter of body-surface area per week for six weeks ( group 1 ) ; 50 mg of cisplatin per square meter on days 1 and 29 , followed by 4 g of fluorouracil per square meter given as a 96-hour infusion on days 1 and 29 , and 2 g of oral hydroxyurea per square meter twice weekly for six weeks ( group 2 ) ; or 3 g of oral hydroxyurea per square meter twice weekly for six weeks ( group 3 ) . RESULTS The analysis included 526 women . The median duration of follow-up was 35 months . Both groups that received cisplatin had a higher rate of progression-free survival than the group that received hydroxyurea alone ( P<0.001 for both comparisons ) . The relative risks of progression of disease or death were 0.57 ( 95 percent confidence interval , 0.42 to 0.78 ) in group 1 and 0.55 ( 95 percent confidence interval , 0.40 to 0.75 ) in group 2 , as compared with group 3 . The overall survival rate was significantly higher in groups 1 and 2 than in group 3 , with relative risks of death of 0.61 ( 95 percent confidence interval , 0.44 to 0.85 ) and 0.58 ( 95 percent confidence interval , 0.41 to 0.81 ) , respectively . CONCLUSIONS Regimens of radiotherapy and chemotherapy that contain cisplatin improve the rates of survival and progression-free survival among women with locally advanced cervical cancer Ninety-two consecutive patients with stages IB and IIA carcinoma of the cervix were treated by one of two regimens : pre-operative intracavitary caesium-137 followed by a Wertheim hysterectomy ( group 1 ) or staging laparotomy with biopsy of suspicious lymph nodes ( group 2 ) ( if there was no evidence of tumour on examination of a frozen section of the lymph nodes a Wertheim hysterectomy was performed , but if a tumour was present the abdomen was closed and a course of radical irradiation given ) . When there was evidence of extracervical spread on examination of the specimen after the Wertheim hysterectomy , postoperative irradiation was given . It was found that clinical staging had been incorrect in 38,5 % of patients thought to have stage IB disease and in 71,4 % of those thought to have stage IIA disease . The actuarial survival curves showed no significant statistical difference between group 1 and group 2 . When examination of the operative specimen showed tumour invasion of the parametrium only , the disease was well controlled by postoperative irradiation ( all 7 such patients survived ) . On the other h and , when there was evidence of tumour invasion of pelvic lymph nodes the 4-year survival rate fell to 31 % ( 4 out of 13 patients ) , despite the use of postoperative irradiation BACKGROUND Bulky stage IB cervical cancers have a poorer prognosis than smaller stage I cervical cancers . For the Gynecologic Oncology Group , we conducted a trial to determine whether weekly infusions of cisplatin during radiotherapy improve progression-free and overall survival among patients with bulky stage IB cervical cancer . METHODS Women with bulky stage IB cervical cancers ( tumor , > or = 4 cm in diameter ) were r and omly assigned to receive radiotherapy alone or in combination with cisplatin ( 40 mg per square meter of body-surface area once a week for up to six doses ; maximal weekly dose , 70 mg ) , followed in all patients by adjuvant hysterectomy .  Women with evidence of lymphadenopathy on computed tomographic scanning or lymphangiography were ineligible unless histologic analysis showed that there was no lymph-node involvement . The cumulative dose of external pelvic and intracavitary radiation was 75 Gy to point A ( cervical parametrium ) and 55 Gy to point B ( pelvic wall ) . Cisplatin was given during external radiotherapy , and adjuvant hysterectomy was performed three to six weeks later . RESULTS The relative risks of progression of disease and death among the 183 women assigned to receive radiotherapy and chemotherapy with cisplatin  , as compared with the 186 women assigned to receive radiotherapy alone , were 0.51 ( 95 percent confidence interval , 0.34 to 0.75 ) and 0.54 ( 95 percent confidence interval , 0.34 to 0.86 ) , respectively . The rates of both progression-free survival ( P<0.001 ) and overall survival ( P=0.008 ) were significantly higher in the combined-therapy group at four years . In the combined-therapy group there were higher frequencies of transient grade 3 ( moderate ) and grade 4 ( severe ) adverse hematologic effects ( 21 percent , vs. 2 percent in the radiotherapy group ) and adverse gastrointestinal effects ( 14 percent vs. 5 percent ) . CONCLUSIONS Adding weekly infusions of cisplatin to pelvic radiotherapy followed by hysterectomy significantly reduced the risk of disease recurrence and death in women with bulky stage IB cervical cancers To investigate whether surgery or radiotherapy should be preferred in the early stages of carcinoma of the cervix a r and omized study was performed in which operable patients with small FIGO stage 2 squamous cell carcinoma were included . Of these patients , 122 were in stage 2A and 20 in stage 2B . The patients were treated with intracavitary radium , followed by either radical surgery with pelvic lymphadenectomy ( Group A , 72 patients ) or high-voltage external irradiation 40 Gy to a pelvic field ( Group B , 70 patients ) . Postoperative irradiation 40 to 50 Gy was given in Group A if lymph node metastases were found at operation . Fourteen patients in Group A and 23 in Group B died of recurrent disease . The 5- , 10- , and 20-year survival in Group A was 87 , 84 and 81 % respectively compared with 72 , 69 , and 68 % in Group B , p < 0.05 . Twenty-three ( 34 % ) of 67 radically operated patients had metastases to pelvic lymph nodes . A high rate of pelvic and para-aortic recurrences accounts for the difference between Groups A and B. Young patients ( < 40 years ) with large tumours had a high risk of recurrent disease . Severe urinary and gastrointestinal complications were more common in Group A , especially among patients given postoperative radiotherapy .  Lymphoedema was seen almost exclusively in Group A. Two patients in Group A and one in Group B died of complications to treatment . The corrected 10-year survival of 69.5 % as achieved in the radiotherapy arm of this series is comparable to other reported studies . The high survival rate in the operated group , despite a very high metastases rate , suggests that surgery is applicable also in stage 2 patients PURPOSE In 1986 , a protocol comparing primary radiation therapy ( RT ) plus hydroxyurea ( HU ) to irradiation plus fluorouracil ( 5-FU ) and cisplatin ( CF ) was activated by the Gynecologic Oncology Group ( GOG ) for the treatment of patients with locally advanced cervical carcinoma . The goals were to determine the superior chemoradiation regimen and to quantitate the relative toxicities . METHODS All patients had biopsy-proven invasive squamous cell carcinoma , adenocarcinoma , or adenosquamous carcinoma of the uterine cervix . Patients underwent st and ard clinical staging studies and their tumors were found to be International Federation of Gynaecology and Obstetrics stages IIB , III , or IVA . Negative cytologic washings and para-aortic lymph nodes were required for entry . Patients were r and omized to receive either st and ard whole pelvic RT with concurrent 5-FU infusion and bolus CF or the same RT plus oral HU . RESULTS Of 388 r and omized patients , 368 were eligible ; 177 were r and omized to CF and 191 to HU .  Adverse effects were predominantly hematologic or gastrointestinal in both regimens . Severe or life-threatening leukopenia was more common in the HU group ( 24 % ) than in the CF group ( 4 % ) . The difference in progression-free survival ( PFS ) was statistically significant in favor of the CF group ( P = .033 ) . The sites of progression in the two treatment groups were not substantially different . Survival was significantly better for the patients r and omized to CF ( P = .018 ) . CONCLUSION This study demonstrates that for patients with locally advanced carcinoma of the cervix , the combination of 5-FU and CF with RT offers patients better PFS and overall survival than HU , and with manageable toxicity The influence of cell type on recurrence-free interval ( RFI ) and survival after radical hysterectomy for patients with Stage IB carcinoma of the cervix was investigated . Patients with Stage IB carcinoma of the cervix ( > 3-mm invasion ) underwent a radical hysterectomy and pelvic lymphadenectomy .  Patients with involved paraaortic nodes or gross extracervical disease were excluded . Of 813 evaluable patients , 645 had squamous , 104 with adenocarcinoma , and 64 had adenosquamous cell type . The time to failure and the following clinical /pathologic characteristics were compared among the three cell types : age , Gynecologic Oncology Group performance status ( PS ) , gross versus occult tumor , histologic grade , depth of invasion , node status , uterine extension , parametrial extension , surgical margins , and capillary-lymphatic space ( CLS ) involvement . A Cox proportional hazards model was used to compare the patients with adenosquamous and adenocarcinoma to those with squamous while adjusting for prognostic factors . The median age was 40 years ( range , 21 - 87 ) . Pelvic nodes were involved in 119 ( 15 % ) of patients . There were no significant differences between cell types in distributions of the following factors : age , PS , positive nodes , depth of invasion , uterine extension , surgical margins , or parametrial extension . There were statistically significant differences between cell types with regards to grade ( P < 0.001 ) , gross versus occult primary status ( P = 0.016 ) , and CLS involvement ( P = 0.005 ) . There was no statistically significant difference detected between cell types in crude comparisons of RFI ( P = 0.29 ) ; however , there was a difference in survival ( P = 0.02 ) with shorter survival seen in the adenosquamous cell type . After adjusting for CLS involvement , PS , depth of invasion , and clinical tumor size , survival remained worse for patients with adenosquamous primaries when compared to squamous carcinoma ( P = 0.02 ) and adenocarcinoma ( P = 0.007 ) . In conclusion , no statistically significant differences were seen in RFI among cell types ; however , in patients with Stage I carcinoma of the cervix overall survival after radical hysterectomy may be slightly worse for those with adenosquamous cell type OBJECTIVE To determine which clinicopathological factors influence the prognosis of cervical adenocarcinoma . METHODS Three hundred and two cases of primary adenocarcinoma of the uterine cervix , treated between 1977 and 1994 , were studied retrospectively . Clinical data and pathological findings with respect to primary therapy were review ed and evaluated . RESULTS The 5-year survival rates for stages I , II , and III/IV were 75.9 , 62.9 , and 25.1 % , respectively . International Federation of Gynecology and Obstetrics stage ( P < 0 . 0001 ) , cell type ( P = 0.0176 ) , tumor grade ( P = 0.023 ) , lymph node status ( P = 0.018 ) , and bulky tumor ( P = 0.007 ) were found to be independent factors using the stepwise Cox proportional hazards model . Old age ( P = 0.0581 ) , presence of hypertension ( P = 0.46 ) , diabetes mellitus ( P = 0.18 ) , obesity ( P = 0.15 ) , and oral contraceptive use ( P = 0.42 ) were not found to adversely influence survival rates for cervical adenocarcinoma after adjusting for other covariates . Adenosquamous adenocarcinoma had a better prognosis than endocervical columnar cell adenocarcinoma in stages I and II ( P = 0 . 0235 ) . Also , in cervical adenocarcinoma 's early stages , multivariate modeling revealed that chances of survival were significantly better for patients treated by radical surgery than for patients treated by radiation therapy ( P < 0.001 ) . CONCLUSIONS Survival rates for cervical adenocarcinoma were significantly influenced by stage , histologic subtype , tumor grade , the presence of a positive lymph node , and tumor size . Although a r and omized prospect i ve study is needed , our data imply that radical surgery may be considered a better primary modality of treatment than radiation therapy for the early stages of cervical adenocarcinoma . Further , the presence of hypertension , diabetes mellitus , or obesity may not adversely influence survival rates OBJECTIVE The incidence of cervical adenocarcinoma is increasing relative to squamous cell carcinoma and all cervical cancers . Few reports have described the outcome of patients with advanced cervical adenocarcinoma . The purpose of this study was to determine the prognostic factors and survival for patients with stage IIB-IVB disease . METHODS Institutional Review Board approval was obtained to perform a computerized search of all women diagnosed with cervical adenocarcinoma at our three institutions between 1982 and 2000 . Medical records were retrospectively review ed . Clinical follow-up was obtained from the SGO data base and tumor registry and via correspondence with health care providers . Statistical analysis was performed using logistic regression for clinical variables and the log-rank test to compare Kaplan-Meier survival estimates . RESULTS Eighty-three women with FIGO stage IIB-IVB cervical adenocarcinoma were identified . The median patient age was 53 years ( range , 22 - 88 ) . The median follow-up of 17 ( 20 % ) surviving patients was 33 months ( range , 6 - 147 ) ; 66 ( 80 % ) died during the study interval . Stage IIB disease , young patient age , and grade 1 histology were independent variables having a favorable impact on survival ( each P < 0.02 ) . Stage IIB patients ( n = 41 ) were more likely to be alive at 2 ( 64 % vs 8 % ) and 5 years ( 30 % vs 0 % ) than women with stage IIIA-IVB disease ( n = 42 ; P < 0.01 ) . CONCLUSIONS Women diagnosed with advanced stage cervical adenocarcinoma have a poor prognosis . Prospect i ve , multicenter trials of platinum-based chemoradiation or other novel therapies are urgently needed in the treatment of this highly lethal disease Abstract One hundred patients with invasive cervical cancer of all stages were r and omly divided into two groups . One of these was treated by means of radical operation and the other with radiation therapy .  Immediate method failure , the inability to complete therapy by the method in question , was considerably higher in the operative group . However , longer term results were more nearly equal in the two . Patients whose disease could not be definitively treated by operation had less than 1 chance in 3 of it being arrested by means of irradiation .  Long-term complications were not a factor in either group . It is concluded that some degree of selection must be made in order to offer each patient the best chance for survival at the least risk . Optimal treatment of cervical malignancy requires the availability of both operative and radiologic skilis BACKGROUND AND METHODS We compared the effect of radiotherapy to a pelvic and para-aortic field with that of pelvic radiation and concurrent chemotherapy with fluorouracil and cisplatin in women with advanced cervical cancer . Between 1990 and 1997 , 403 women with advanced cervical cancer confined to the pelvis ( stages IIB through IVA or stage IB or IIa with a tumor diameter of at least 5 cm or involvement of pelvic lymph nodes ) were r and omly assigned to receive either 45 Gy of radiation to the pelvis and para-aortic lymph nodes or 45 Gy of radiation to the pelvis alone plus two cycles of fluorouracil and cisplatin ( days 1 through 5 and days 22 through 26 of radiation ) . Patients were then to receive one or two applications of low-dose-rate intracavitary radiation , with a third cycle of chemotherapy planned for the second intracavitary procedure in the combined-therapy group . RESULTS Of the 403 eligible patients , 193 in each group could be evaluated . The median duration of follow-up was 43 months . Estimated cumulative rates of survival at five years were 73 percent among patients treated with radiotherapy and chemotherapy and 58 percent among patients treated with radiotherapy alone ( P=0.004 ) . Cumulative rates of disease-free survival at five years were 67 percent among patients in the combined-therapy group and 40 percent among patients in the radiotherapy group ( P<0.001 ) . The rates of both distant metastases ( P<0.001 ) and locoregional recurrences ( P<0.001 ) were significantly higher among patients treated with radiotherapy alone . The seriousness of side effects was similar in the two groups , with a higher rate of reversible hematologic effects in the combined-therapy group . CONCLUSIONS The addition of chemotherapy with fluorouracil and cisplatin to treatment with external-beam and intracavitary radiation significantly improved survival among women with locally advanced cervical cancer PURPOSE Definitive radiation therapy alone or combined with surgery in carcinoma of the uterine cervix yields comparable tumor control and survival in Stages I and IIA when patients are adequately treated with either modality . Our 30-year institutional experience is described . METHODS AND MATERIAL S This is a nonr and omized comparison of treatment results of 415 patients with Stage IB , 137 with Stage IIA , and 340 with Stage IIB carcinoma of the uterine cervix treated with irradiation alone and 197 with Stage IB , 44 with Stage IIA , and 65 with limited Stage IIB treated with pre- or postoperative irradiation and surgery . Irradiation alone consisted of a combination of external beam therapy and intracavitary insertions to deliver doses of 70 to 85 Gy to point A for patients with Stages IB and IIA disease and 80 to 90 Gy for patients with bulky or Stage IIB tumors . For patients treated with irradiation and surgery , various combinations of external beam and intracavitary therapy were used to deliver 60 to 75 Gy to point A. Surgical procedures consisted of radical hysterectomy with or without lymph node dissection in 130 patients with Stage IB , 28 patients with Stage IIA , and 10 patients with limited Stage IIB . Fifty-seven patients had total abdominal or conservative hysterectomy with or without lymph node dissection , and 3 had vaginal hysterectomy . In addition , 51 patients with Stage IIB tumors underwent pelvic lymphadenectomy after definitive irradiation . RESULTS The 5-year cause-specific survival ( CSS ) rates for patients with Stage IB nonbulky tumors treated with irradiation alone or irradiation combined with surgery were 90 and 85 % , respectively , and the 10-year survival rate was 84 % with either modality . In patients with bulky tumors ( > 5 cm ) , the 5-year CSS rates were 61 % with irradiation alone and 63 % with irradiation plus surgery ; at 10 years the rates were 61 and 68 % , respectively ( p = 0.5 ) . For those with Stage IIA nonbulky tumors , the 5-year CSS rates were 75 % with irradiation alone and 83 % with combined irradiation and surgery , and 10-year CSS rates were 66 and 71 % , respectively . In patients with Stage IIA bulky tumors , the 5-year CSS rates were 69 % with irradiation alone and 60 % with irradiation plus surgery , and at 10 years , 69 and 44 % , respectively ( p = 0.05 ) . In patients with Stage IIB nonbulky tumors treated with irradiation alone or combined with surgery , the 5- and 10-year CCS rates were 72 and 65 % , respectively ; the corresponding survival rates with bulky tumors or bilateral parametrial involvement were 56 and 50 % . Incidence of pelvic failures , alone or with distant metastasis , for Stage IB was 10 % ( 43 out of 415 ) with irradiation alone and 14 % ( 28 of 197 ) with irradiation plus surgery ; for Stage IIA , 17 % ( 23 out of 137 ) with irradiation alone and 20 % ( 9 our of 44 ) with irradiation plus surgery ; and for Stage IIB , 23 % ( 88 out of 391 ) with irradiation alone and 29 % ( 4 out of 14 ) with irradiation plus surgery .  Grade 3 sequelae were comparable in both groups ( irradiation alone , 5 % to 11 % ; irradiation combined with surgery , 8 % to 12 % ) ; the differences are not statistically significant . The most frequent major sequelae in 892 patients receiving irradiation only were rectovaginal fistula ( 13 cases , 1.5 % ) , proctitis ( 10 , 1.1 % ) , small bowel obstruction ( 16 , 1.8 % ) , ureteral stricture ( 16 , 1.8 % ) , and vesicovaginal fistula ( 8 , 0.9 % ) . In 306 patients treated with  irradiation plus surgery , the most commonly recorded major sequelae were small bowel obstruction/perforation ( 13 cases , 4.2 % ) , ureteral stricture ( 8 , 2.6 % ) , vesicovaginal fistula ( 5 , 1.6 % ) , and rectovaginal fistula ( 4 , 1.3 % ) . CONCLUSION Irradiation alone or combined with surgery yields comparable pelvic tumor control , survival , and morbidity in patients with Stage IB , IIA , and limited IIB carcinoma of the uterine cervix In a retrospective survey , 487 research projects approved by the Central Oxford Research Ethics Committee between 1984 and 1987 , were studied for evidence of publication bias . As of May , 1990 , 285 of the studies had been analysed by the investigators , and 52 % of these had been published . Studies with statistically significant results were more likely to be published than those finding no difference between the study groups ( adjusted odds ratio [ OR ] 2.32 ; 95 % confidence interval [ Cl ] 1.25 - 4.28 ) . Studies with significant results were also more likely to lead to a greater number of publications and presentations and to be published in journals with a high citation impact factor . An increased likelihood of publication was also associated with a high rating by the investigator of the importance of the study results , and with increasing sample size . The tendency towards publication bias was greater with observational and laboratory-based experimental studies ( OR = 3.79 ; 95 % Cl = 1.47 - 9.76 ) than with r and omised clinical trials ( OR = 0.84 ; 95 % Cl = 0.34 - 2.09 ) . We have confirmed the presence of publication bias in a cohort of clinical research studies . These findings suggest that conclusions based only on a review of published data should be interpreted cautiously , especially for observational studies . Improved strategies are needed to identify the results of unpublished as well as published studies
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 review s about surgery versus chemoradiation in the treatment of cervical cancer .
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 .