Should Adenocarcinoma of Cervix be Treated Differently to Squamous Cell Carcinoma?

Aim: The purpose of this study was to evaluate the overall survival (OS), relapse-free survival (RFS) and patterns of failure, in patients with SCC and ADC of cervix treated with definitive radiotherapy and to determine whether ADC should be treated differently. Methods: Total of 494 patients treated between January 1996 and December 2012 with definitive radiotherapy were included for analysis. Survival probabilities were estimated using Kaplan–Meier method, and differences between the groups were compared using long-rank test. Cox proportional hazards models were used to determine the role of histology after adjusting for potential confounders impacting on survival. Results: The 5-year RFS of node-negative SCC and ADC was 79% and 75% and of node-positive SCC and ADC was 51% and 37%, respectively. The 5-year OS was 74% for both node-negative SCC and ADC and 54% and 42% for node-positive SCC and ADC, respectively. This difference in RFS and OS among these four subgroups was not significant. The tumour volume (p = 0.005), corpus invasion (p = 0.022) and lymph node involvement (p < 0.001) were significant predictors of RFS, whereas histology (p = 0.204) was not. Increasing age (p < 0.001), ECOG performance score 2 (p = 0.04), tumour volume (p = 0.009) and lymph node involvement (p < 0.001) were predictive for OS, but histology (p = 0.458) was not. There was no difference in pelvic and extra-pelvic failure of the two histological subtypes. Conclusion: Both these histological types exhibit similar clinical behaviour and survival when matched for prognostic factors. Hence, current standard of care was equally effective in both histological types.