Journal article
Revisiting Milan cervical cancer study: Do the original findings hold in the era of chemotherapy?
Gynecologic oncology, v 144(2), pp 299-304
01 Feb 2017
PMID: 27899201
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
The primary treatment of early stage cervical carcinoma (IB-IIA) is either surgery or radiation therapy based on the pivotal Milan randomized study published twenty years ago. In the presence of high-risk features, the gold standard treatment is concurrent chemotherapy and radiation therapy (CRT) whether it is the in the postoperative or the definitive setting. Using the National Cancer Data Base (NCDB), the goal of our study is to compare the outcomes of surgery and radiation therapy in the chemotherapy era.
Between 2004 and 2013, 5478 patients diagnosed with early stage cervical cancer were divided into 2 groups based on their primary treatment: non-surgical (n=1980) and surgical groups (n=3498). The distribution of patient/tumor characteristics and treatment variables with their relation to overall survival and proportional regression models were assessed to investigate the superiority of one approach over the other. Propensity score analysis adjusted for imbalance of covariates to create a well-matched-patient cohort.
At 46months median follow-up, the 5-year overall survival was similar between both groups (73·8% vs. 75.7%; p=0.619) after applying propensity score analysis. On multivariate analysis, high Charlson comorbidity score, stage IIA disease, larger tumor size, positive lymph nodes and high-grade disease were significant predictors of poor outcome while older age and treatment approach were not.
Our analysis suggests that surgery (followed by adjuvant RT or CRT) and definitive radiotherapy (with or without chemotherapy) result in equivalent survival. Prospective studies are warranted to establish this paradigm in the chemotherapy era.
•Radiation and Hysterectomy are equivalent in treating early stage cervical cancer•Concurrent chemotherapy is of benefit in the definitive and adjuvant setting•The benefit of chemotherapy has never been directly compared for each modality•Definitive and adjuvant chemoradiation provide similar overall survival
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Details
- Title
- Revisiting Milan cervical cancer study: Do the original findings hold in the era of chemotherapy?
- Creators
- W. Ross Green - Rutgers, The State University of New JerseyLara Hathout - Rutgers, The State University of New JerseyAtif J Khan - Rutgers, The State University of New JerseyMohamed A Elshaikh - Henry Ford HospitalSushil Beriwal - UPMC Hillman Cancer CenterWilliam Small - Loyola University ChicagoOmar Mahmoud - Rutgers, The State University of New Jersey
- Publication Details
- Gynecologic oncology, v 144(2), pp 299-304
- Publisher
- Elsevier
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Radiation Oncology (and Nuclear Medicine)
- Web of Science ID
- WOS:000392885200016
- Scopus ID
- 2-s2.0-85007441120
- Other Identifier
- 991021897387404721
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- Collaboration types
- Domestic collaboration
- Web of Science research areas
- Obstetrics & Gynecology
- Oncology