It is of interest to note that despite the treatment of thousands of cases of carcinoma of the cervix by surgical and radiotherapeutic means, a randomized study has not been presented in the literature to clearly demonstrate the superiority of one treatment method as compared to the other. Since the ethics of such a study are beyond question in early stage carcinoma of the cervix, a question to ask is why the absence of a definitive study, considering the cooperation achieved in many large centers between the gynecological and radiological disciplines.
The answer is that the sampling and cross section of patients are different. This factor of selection has been recently stressed by Kottmeier,9 in that patients at different centers chosen for surgery as contrasted to radiotherapy are not of equal clinical quality. This is already apparent in a well-designed study at the University of Michigan,10 in which