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Long-Term Morbidity and Quality of Life in Cervical Cancer Survivors: A Multicenter Comparison Between Surgery and Radiotherapy as Primary Treatment
  1. Marloes Derks, MD,
  2. Luc R.C.W. van Lonkhuijzen, MD, PhD,
  3. Rinske M. Bakker, MSc,
  4. Anne M. Stiggelbout, PhD,
  5. Cornelis D. de Kroon, MD, PhD,
  6. Henrike Westerveld, MD, PhD,
  7. Jan Paul W.R. Roovers, MD, PhD,
  8. Gemma G. Kenter, MD, PhD and
  9. Moniek M. ter Kuile, PhD
  1. * Department of Gynaecologic Oncology, Academic Medical Center, Centre for Gynaecological Oncology, Amsterdam;
  2. Department of Gynaecology,
  3. Department of Medical Decision Making, Leiden University Medical Center, Leiden;
  4. § Department of Radiotherapy and
  5. Department of Gynaecology, Academic Medical Center, Amsterdam, the Netherlands.
  1. Address correspondence and reprint requests to Marloes Derks, MD, Department of Gynecologic Oncology, Academic Medical Center, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands. E-mail: m.deks{at}


Objective To compare long-term morbidity and quality of life after primary surgery or primary radiotherapy for stage IB/II cervical cancer.

Methods A cross-sectional study was performed. Patients treated for stage IB/II cervical cancer between 2000 and 2010 were approached to participate. Primary treatment consisted of radical hysterectomy with pelvic lymphadenectomy (RHL), for selected cases followed by adjuvant (chemo-)radiotherapy, or primary (chemo)radiotherapy (PRT). European Organization for Research and Treatment of Cancer-C30 and European Organization for Research and Treatment of Cancer-CX24 questionnaires were administered. A multivariable analysis was performed to identify factors associated with morbidity/quality of life. In a subgroup analysis, we compared patients with RHL + adjuvant radiotherapy with those after PRT.

Results Three hundred twenty-three cervical cancer survivors were included (263 RHL/60 PRT). In the PRT group, International Federation of Gynecology and Obstetrics stage was higher and women were older. In the RHL group, more women had a partner. Women treated with PRT reported lower physical (β, −6.01) and social functioning (β, −15.2), more financial problems (β, 10.9), diarrhea (β, 9.98), symptom experience (β, 6.13), sexual worry (β, 11.3), and worse sexual/vaginal functioning (β, 11.4). Women treated with RHL reported significantly more lymphedema (β, −16.1). No differences in global health were found. In the subgroup analysis, women after PRT (n = 60) reported poorer social functioning, less sexual enjoyment, and higher symptoms experience than women after RHL and adjuvant radiotherapy (n = 60). The latter reported more lymphedema.

Conclusions Although global health scores are not significantly different, women after PRT report more physical, social, and sexual symptoms. These results can be well used by physicians to inform their patients about treatment-related morbidity.

  • Cervical cancer
  • Radical hysterectomy
  • Radiotherapy
  • Morbidity
  • Quality of life

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  • The authors declare no conflicts of interest.