Older Women With Early Cervical Cancer Are Less Likely to Have Surgery

Dario R. Roque, MD

Among patients with early-stage cervical cancer, women aged >65 years are less likely than younger women to be treated with surgery as compared with chemoradiation, according to a study presented at ASCO 2012.

A secondary analysis of the data in the retrospective study suggested that the trend toward chemoradiation might be safer for the older group, who, when treated surgically, faced a 3-fold increase in their risk of disease-specific mortality and a 6.5-fold increase in their risk of all-cause mortality.

“We know from past trials that these two treatments are equivalent [in their effectiveness] for lower-stage disease,” said Dario R. Roque, MD, a resident in Obstetrics and Gynecology at Women & Infants Hospital in Providence, Rhode Island. “Doctors may believe that some of their older patients are too frail or have too many comorbidities to tolerate surgery well, but there’s not a lot of evidence to suggest that surgery may not be a good option. I wanted to see if age was influencing that decision.”

In the study, Roque and his co-authors sought to determine whether the elderly status of patients with stage IB1-IIB cervical carcinoma affected their treatment choice or outcome. The study included 303 patients treated at Women & Infants Hospital between 2000 and 2010.

Based on age, the patients were separated into two groups: <65 years and ≥65 years. There was no difference in the distribution of tumor histology, stage, or grade between the two groups.

The investigators found that younger women with stage IB1 cervical cancer were over 25% more likely to receive surgery than the older women in that population. No differences in treatment allocation were found when comparing older and younger women who had other stages of the disease, Roque said.

The study was an opportunity to get a snapshot of current practice for the treatment of this population at Women & Infants Hospital, Roque said. While the suggested decrease in survival for older women treated with surgery is intriguing, he said, that secondary finding would need to be confirmed in a randomized, controlled study in order to justify a change in practice guidelines.

“This is something we should be looking at more specifically to know whether, for women with early-stage cervical cancer who are over 65, we should just give chemoradiation and never surgery,” Roque said. “The problem is that cervical cancer is rare in the United States. To answer the question we would need a large number of patients, so the study would take a long time to do.”

Roque DR, Cronin B, Robison K, et al. The effects of age on treatment and outcomes in women with stage IB-IIB cervical cancer. J Clin Oncol. 2012;30(suppl; abstr 5100).