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Gynaecology: Cervix — concurrent chemoradiotherapy evidence

Free question published 16 August 2026

GynaecologyCervix — concurrent chemoradiotherapy evidence

An ST6 trainee is asked at a teaching session to summarise the pivotal evidence underpinning concurrent chemoradiotherapy for locally advanced cervical cancer. In the trial reported by Morris and colleagues in 1999, women with high-risk cervical cancer were randomised to pelvic plus para-aortic radiation alone versus pelvic radiation with concurrent fluorouracil and cisplatin. Which statement most accurately reflects the result that helped change practice?

  1. AConcurrent chemoradiotherapy improved local control but worsened overall survival
  2. BThere was no significant difference in survival between the two arms
  3. CConcurrent chemoradiotherapy improved 5-year overall survival from 58% to 73%
  4. DExtended-field para-aortic radiotherapy alone was superior to concurrent chemoradiotherapy
  5. EConcurrent chemoradiotherapy improved overall survival but only in node-negative disease

Why C is correct

In Morris et al (NEJM 1999), the estimated 5-year survival was 73% with radiotherapy plus concurrent fluorouracil and cisplatin versus 58% with radiotherapy alone (P=0.004), with disease-free survival of 67% versus 40% (P<0.001). This was one of the trials that prompted the 1999 NCI clinical alert recommending concurrent cisplatin-based chemoradiotherapy.

And why the others are not

  • AIncorrect. Concurrent chemoradiotherapy improved, not worsened, overall survival.
  • BIncorrect. The survival difference was statistically significant (P=0.004).
  • DIncorrect. Pelvic and para-aortic radiotherapy alone was the inferior comparator arm.
  • EIncorrect. The benefit was not restricted to node-negative disease; the eligible population included node-positive and bulky tumours.

Source Morris et al — pelvic radiation with concurrent chemotherapy vs pelvic and para-aortic radiation for high-risk cervical cancer — Morris M, Eifel PJ, Lu J, et al. Pelvic radiation with concurrent chemotherapy compared with pelvic and para-aortic radiation for high-risk cervical cancer. N Engl J Med, 1999.

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