A long standing debate about the right treatment for advanced cervical cancer tumours (larger than 4cms) has now been set to rest, given the findings of a decade-long study carried out by the Tata Memorial Hospital in Mumbai. The study concludes that the chemotherapy followed by radiation therapy works better in such advanced stages of tumor treatment, rather than chemotherapy followed by surgery. "This is the first ever study that compares the two treatment strategies and gives us a conclusive decision as to which one is more preferable and must be taken up," says Dr Sudeep Gupta, head of medical oncology at Tata Memorial Hospital and one who spearheaded the study.
Dr Sharma, Dean at Tata Memorial Hospital says, "This study was the need of the hour. It gives a clear cut picture and that is commendable. Indian women mostly fall prey to cervical cancer due to poor hygiene and are most commonly found in the advanced stage, that is with tumours larger than 4cms, because of the time lost due to late diagnosis." 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 per cent, in the latter it was 69.3 per cent. 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.
One reason for doctors to take up the surgery route is the lack of radiation therapy facilities, says Dr Sharma. "We need to have the right infrastructure in place and the government needs to take it seriously."
According to data on the National Health Portal, "India has a population of 436.76 million women aged 15 years and older who are at risk of developing cervical cancer. According to estimations from 2012, every year 1,22,844 women are diagnosed with cervical cancer and 67477 die from the disease. In India, cervical cancer is the second most common cancer among women and also the second most common cancer among women between 15 and 44 years of age."
Another study from TMH, published in Journal of the American Medical Association (JAMA) last month, researches on advanced form of cervical cancer through 850 women in a clinical trial. It found that the group treated by combination of chemotherapy and radiation were better off than those undergoing radiation alone.