Two major studies presented at the Tata Memorial Hospital (TMH) on Wednesday revealed that surgical intervention can be ruled out for treating cervical cancers where tumours are larger than 4 cm. Both studies, announced on the occasion of International Women‘s Day, have shown that concurrent chemotherapy and radiotherapy give better disease-free survival rates.
In the first study, which looked at locally advanced cervical cancers, patients showed a 7% better disease-free survival rate when treated with chemotherapy and radiotherapy simultaneously as compared to chemotherapy and surgery.
Settling a debate
The study, which was recently published in the Journal of Clinical Oncology, was carried out between September 2003 and February 2015.
A total of 633 women with locally advanced stage (IB2, IIA or IIB) squamous cervical cancers were recruited. While 316 patients were put in the chemotherapy and surgery arm, 317 patients were put in the concurrent chemo-radiotherapy arm. The five-year disease-free survival rate in chemotherapy plus surgery group was found to be 69.3% as compared to 76.7% in the chemo-radiotherapy group.
“There has been a long, ongoing debate on the appropriate treatment for locally advanced cervical cancers. Worldwide, some doctors offer the chemotherapy plus surgery option while some go by chemo-radiotherapy. No one was certain about which treatment resulted in higher cure rates,” said medical oncologist Sudeep Gupta from Tata Memorial Hospital, one of the authors of the study. “This is the first time we have compared the two treatment strategies, and we found that concurrent chemo-radiotherapy was better than the chemotherapy with surgical intervention,” he said. A similar study is being carried out in Europe and its results are awaited, Dr. Gupta said.
The second study, published in the Journal of the American Medical Association Oncology, looked at much more advanced Stage 3 cervical cancers and their response to radiotherapy alone and concurrent chemo-radiotherapy. The study conducted from July 2003 to September 2011 also showed a significantly high five-year disease-free survival rate in concurrent chemo-radiotherapy patients as compared to radiotherapy alone.
Radiotherapy facilities
The emphasis on radiotherapy has brought into focus the inadequate number of radiotherapy facilities in India. At present, the country has 350-odd radiotherapy units with linear accelerators, as against the estimated requirement of 2,000.
There are 232 facilities with brachytherapy (used for internal radiation). Most of these are concentrated in the urban areas. “We want to spread a message that more radiation facilities should be made available,” said Amita Maheshwari, gynaecological oncologist at TMH.
Inappropriate staging
Cervical cancer affects more than 1.3 lakh women every year. Nearly 67,000 women die due to the disease annually. Experts say that most patients seek medical help at an advanced stage.
“Many of these women have suboptimal surgeries due to inappropriate staging of cancers by the doctors in the community. Therefore, it is very important that cervical cancer care is provided in oncology centres,” said Supriya Chopra, professor of radiation oncology at TMH. Dr. Chopra said she receives at least 100 women annually who have undergone suboptimal surgeries.
The findings have been updated as guidelines under the National Cancer Grid. The doctors are updating the Indian Council of Medical Research guidelines as well.
