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.