Chemo-radiation therapy cures cervical cancer better, says study

A combination of chemo and radiation therapy works better in advanced cervical cancer tumours as compared to chemo followed by surgery, suggests findings from a decade long study by the Tata Memorial Hospital (TMH).

Tumours larger than four centimetres, commonly seen among Indian women because of late diagnosis, are considered to be of advanced stage.

Doctors said, the findings have answered the long standing debate about which is the better treatment option – chemo and radiation therapy, or chemotherapy followed by surgery.

“This is the first ever study to compare the two treatment strategies. Until now, no one was certain about which treatment mode resulted in higher cure rates,” said Dr Sudeep Gupta, medical oncologist at TMH, the lead author of the study.

Although India has seen a fall in the incidences of cervical cancer over the last three decades, the number of cases is high in areas, where sanitation and hygiene are poor, said doctors.

Out of the total 633 patients who were part of the study, 317 patients were given concurrent chemo and radiation therapy. The other group was first given chemotherapy to reduce the tumour size, after which 227 patients, who were eligible for surgery were operated.

While in the former group, the five-year disease-free survival rate was 76.7%, in the latter it was 69.3%.

In clinical trials, measuring the disease-free survival is one way to see how well a new treatment works. The findings were published in the Journal of Clinical Oncology on February 11.

“Our study has laid the controversy to rest. Women with stage 1B and 2 (advanced stages) cervical cancer should be offered chemo plus radiotherapy as the standard option,” Dr Gupta said.

This study, doctors said, assumes importance as 60 to 70% women in India are diagnosed with cervical cancer at a late stage, where the tumour would have grown over four cms. Moreover, over the last three decades, chemotherapy followed by surgery has been considered as an ‘attractive approach’ by many doctors. However, no studies till date have estimated the number of advance stage cervical cancer patients treated with surgery.

“It is very difficult to ascertain that number, all the more in India, where anyone and everyone treats cancer,” said Dr Amita Maheshwari, gynaecology oncologist, at the TMH.

She said that lack of radiation therapy facilities in the country is another reason that pushes doctors to take surgery route.

A 2017 report called Call for Action: expanding cancer care for women, by Ernest and Young, showed that there are around 400 radiotherapy machines installed, whereas the required figure is 1,900-2,000.

Doctors said there is a need for the government to increase the radiotherapy facilities.

Dr Supriya Chopra, professor, radiation oncology, said that the National Cancer Grid is in the process of formulating guidelines for cervical cancer treatment and will present the estimate of the number of radiation therapy facilities needed, to the government, in the coming months.