Maria Bjurberg1, Erik Holmberg2, Christer Borgfeldt3, Angelique Flöter-Rådestad4, Pernilla Dahm-Kähler5, Elisabet Hjerpe6, Thomas Högberg7, Preben Kjølhede8, Janusz Marcickiewicz9, Per Rosenberg10, Karin Stålberg11, Bengt Tholander12, Kristina Hellman13, Elisabeth Åvall-Lundqvist10. 1. Department of Haematology, Oncology and Radiation Physics, Skåne University Hospital, and Department of Clinical Sciences, Lund University, SE-22185 Lund, Sweden. Electronic address: maria.bjurberg@med.lu.se. 2. Region Västra Götaland, Regional Cancer Centre West, SE-41345 Gothenburg, Sweden; Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, SE-41345 Gothenburg, Sweden. 3. Department of Obstetrics and Gynaecology, Skåne University Hospital and Lund University, SE-22185 Lund, Sweden. 4. Department of Women's and Children's Health, Division of Obstetrics and Gynaecology, Karolinska Institutet, Karolinska University Hospital, SE-17176 Stockholm, Sweden. 5. Department of Obstetrics and Gynaecology, Sahlgrenska University Hospital, SE-41345 Gothenburg, Sweden. 6. Department of Gynaecology and Obstetrics, Visby Hospital, SE-62155 Visby, Sweden. 7. Department of Cancer Epidemiology, Lund University, SE-22100 Lund, Sweden. 8. Department of Obstetrics and Gynaecology, Linköping University Hospital, SE-58185 Linköping, Sweden; Department of Clinical and Experimental Medicine, Linköping University, SE-58185 Linköping, Sweden. 9. Region Västra Götaland, Regional Cancer Centre West, SE-41345 Gothenburg, Sweden; Department of Obstetrics and Gynaecology, Halland Hospital, SE-43281 Varberg, Sweden. 10. Department of Oncology and Department of Clinical and Experimental Medicine, Linköping University, SE-58185 Linköping, Sweden. 11. Department of Women's and Children's Health, Uppsala University, SE-75185 Uppsala, Sweden. 12. Department of Oncology, Uppsala University Hospital, SE-75185 Uppsala, Sweden. 13. Department of Gynaecologic Cancer, Theme Cancer, Karolinska University Hospital, SE-171 76 Stockholm, Sweden.
Abstract
OBJECTIVE: Survival in cervical cancer has improved little over the last decades. We aimed to elucidate primary treatment patterns and survival. METHODS: Population-based study of patients included in the Swedish Quality Registry for Gynecologic Cancer diagnosed 2011-2015. Main outcome was 5-year relative survival (RS). Age-standardised RS (AS-RS) was estimated for the total cohort and for the pooled study population of squamous, adenosquamous-, adenocarcinoma. RESULTS: Median follow-up time was 4.6 years. The study population consisted of 2141 patients; 97% of the 2212 patients in the total cohort and the 5-year AS-RS was 71% and 70%, respectively. RS stage IB1: surgery alone 95% vs. 72% for definitive chemoradiotherapy (CT-RT) (p < 0.001). In stage IIA1 74% had CT-RT, and 47% of operated patients received adjuvant (CT)-RT. RS stage IB2: surgically treated 81% (69% received adjuvant (CT)-RT) vs. 76% for (CT)-RT (p = 0.73). RS stage IIB: 77% for CT-RT + brachytherapy (BT), 37% for RT + BT (p = 0.045) and 27% for RT-BT (p < 0.001). Stages III-IVA; <40% received CT-RT + BT, RS 45% vs. 18% for RT-BT (RR 4.1, p < 0.001). RS stage IVB 7%. CONCLUSION: Primary treatment of cervical cancer in Sweden adhered to evidence-based standard of care. Areas of improvement include optimising treatment for stages III-IVA, and avoiding combining surgery and radiotherapy.
OBJECTIVE: Survival in cervical cancer has improved little over the last decades. We aimed to elucidate primary treatment patterns and survival. METHODS: Population-based study of patients included in the Swedish Quality Registry for Gynecologic Cancer diagnosed 2011-2015. Main outcome was 5-year relative survival (RS). Age-standardised RS (AS-RS) was estimated for the total cohort and for the pooled study population of squamous, adenosquamous-, adenocarcinoma. RESULTS: Median follow-up time was 4.6 years. The study population consisted of 2141 patients; 97% of the 2212 patients in the total cohort and the 5-year AS-RS was 71% and 70%, respectively. RS stage IB1: surgery alone 95% vs. 72% for definitive chemoradiotherapy (CT-RT) (p < 0.001). In stage IIA1 74% had CT-RT, and 47% of operated patients received adjuvant (CT)-RT. RS stage IB2: surgically treated 81% (69% received adjuvant (CT)-RT) vs. 76% for (CT)-RT (p = 0.73). RS stage IIB: 77% for CT-RT + brachytherapy (BT), 37% for RT + BT (p = 0.045) and 27% for RT-BT (p < 0.001). Stages III-IVA; <40% received CT-RT + BT, RS 45% vs. 18% for RT-BT (RR 4.1, p < 0.001). RS stage IVB 7%. CONCLUSION: Primary treatment of cervical cancer in Sweden adhered to evidence-based standard of care. Areas of improvement include optimising treatment for stages III-IVA, and avoiding combining surgery and radiotherapy.