JAMA News – Adjuvant Chemoradiotherapy vs Radiotherapy Alone in Intermediate-Risk Cervical Cancer: No Survival Advantage

Adjuvant Chemoradiotherapy vs Radiotherapy Alone in Intermediate-Risk Cervical Cancer: No Survival Advantage

A major cohort study published in JAMA Oncology challenges the common practice of combining chemotherapy with radiotherapy after surgery in patients with intermediate-risk cervical cancer, finding no survival benefit over radiotherapy alone.

🎯 Study Objective

To evaluate whether adjuvant chemoradiotherapy (CRT) offers superior overall survival compared to radiotherapy (RT) alone following radical hysterectomy in stage IB cervical carcinoma.

🧪 Methods

  • Data source: National Cancer Database (2010–2019)
  • Population: 1,116 patients with intermediate-risk cervical cancer
  • Design: Retrospective cohort with propensity score matching
  • Final matched cohort: 868 patients (CRT vs RT)

👩‍⚕️ Patient Profile

  • Mean age: 47 years
  • 43.5% received chemoradiotherapy
  • Chemotherapy more commonly given in:
    • Adenocarcinoma
    • Larger tumors

📊 Key Findings

  • 5-year survival:
    • CRT group: 87%
    • RT group: 87%
  • Hazard Ratio (HR): 0.85 (P = 0.38) → No statistically significant difference
  • Subgroup analysis: No survival advantage based on tumor size or histology

🩺 Clinical Implications

  • No clear benefit of adding chemotherapy in this population
  • Suggests the need for treatment de-escalation in intermediate-risk patients
  • Promotes evidence-based treatment selection to avoid overtreatment and reduce unnecessary toxicity

🔍 Looking Ahead

  • Encourages further research to refine adjuvant treatment protocols
  • Highlights the importance of individualized care decisions
  • Supports re-evaluation of current guidelines in light of non-superior outcomes

🧠 Takeaway: In intermediate-risk cervical cancer, radiotherapy alone may be sufficient, sparing patients from the added burden of chemotherapy without compromising survival.

🔗 Full article: JAMA Oncology – CRT vs RT in Cervical Cancer

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