Skip the scalpel.
The Study: CRT has been the standard of care for bulky and advanced cervical cancer for nearly two decades. Surgery has been posed as an option, though, for patients with stage IB-II disease with the hope of reducing long-term toxicity. The folks at Tata Memorial Centre in India are back at it with another informative randomized trial, this one of women with IB2-IIB cervical cancer receiving either standard CRT or neoadjuvant carbo/taxol x 3 followed by radical hysterectomy. Nonresponders crossed over to CRT after 2 cycles of neoadjuvant chemo, and those with unresectable and/or nodal disease all got CRT (22% in total). Adjuvant radiation or CRT was also given for Sedlis (10%) and Peters (13%) criteria, respectively. The primary outcome of disease free survival at 5 years was significantly better with CRT (77% vs 69%). To no surprise, neoadjuvant chemo had a worse rate of heme toxicity, and radiation had a worse rate of vaginal toxicity. Bladder and GI toxicity rates were identical between groups. And the rate of Tata trial results coming to us from across the Atlantic is so high it may get tariffed.
Bottom Line: For patients with IB2-IIB cervical cancer, CRT is more effective and no more toxic than chemo and surgery. Simply put, chemoradiation remains the standard for all localized cervical cancer >4 cm.