Randomized study of preoperative radiation and surgery or irradiation alone in the treatment of stage IB and IIA XXXX : final report.

@entity1 @entity5 @entity4272 @entity2622 @entity3622 @entity789 @entity3
A prospective randomized study in selected @entity1 with Stage IB and IIA @entity2622 was carried out at Washington University between January 1966 and December 1979. @entity1 were randomized to be treated with irradiation alone consisting of 1000 cGy whole pelvis, additional 4000 cGy to the parametria with a step wedge midline block, and two intracavitary insertions for 7500 mgh; or irradiation and surgery, consisting of 2000 cGy whole pelvis irradiation, one intracavitary insertion for 5000-6000 mgh followed 2 to 6 weeks later by a radical hysterectomy with pelvic lymphadenectomy. A total of 40 @entity1 with Stage IB and 16 with Stage IIA were randomized to be treated with irradiation alone. A similar group of 48 @entity1 with Stage IB and 14 with IIA were randomized to the preoperative radiation and surgery group. The 5-year, @entity5 -free actuarial survival for Stage IB @entity1 treated with radiation was 89% and with preoperative radiation and surgery 80%. In Stage IIA, the @entity5 -free actuarial 5-year survival was 56% for the irradiation alone group and 79% for the @entity1 treated with preoperative radiation and radical hysterectomy. In the @entity1 with Stage IB treated by irradiation alone only one pelvic failure combined with distant @entity3 occurred, and 3 @entity1 developed distant @entity3 . In the 48 @entity1 treated with combined therapy, there were six pelvic failures (12.5%) all combined with distant metastases and two distant metastases alone. In the 16 @entity1 with Stage IIA treated with radiotherapy alone, there were four pelvic failures (all parametrial), three of them combined with distant @entity3 . In the 14 @entity1 treated with irradiation and surgery, two developed a pelvic recurrence, and one distant @entity3 . In the preoperative radiation group, the incidence of metastatic pelvic lymph nodes was 6.3% in Stage IB and 7.1% in Stage IIA. Major complications of therapy in the @entity1 treated with radiation alone (10%) consisted of one @entity3622 , two @entity789 , and one rectal stricture. In the preoperative radiation group, three ureteral strictures and two severe @entity4272 were noted (8%). The present study shows no significant difference in therapeutic results or morbidity for invasive @entity2622 Stage IB or IIA treated with irradiation alone or combined with a radical hysterectomy and lymphadenectomy.
