Introduction/Background In early stage cervical cancer (CC), ESMO/ESTRO guidelines recommend the avoidance of combining radical surgery and radiotherapy due to the higher morbidity. Surgery is the preferred treatment for selected patients to avoid late-effects from chemoradiotherapy (CRT). Still, there are considerable differences in the workup and treatment in Europe. Pelvic MRI and clinical examination is part of the mandatory work-up for treatment selection at Oslo University Hospital (OUH). We evaluated this strategy in FIGO (2009) IB1 patients.
Methodology Patients with stage IB1 treated at OUH between 2005 and 2015 were identified from our institutional database. Patients with fertility-sparing surgery or neuroendocrine tumors were excluded. End of follow-up was Febr 1st 2019. Descriptive statistics were used. Survival was calculated with the Kaplan-Meier method.
Results 340 patients were identified, 63% with squamous carcinoma and 34% with adenocarcinoma. Mean age was 46 years. The median follow-up time was 6.0 years. 19 patients (6%) were treated with neoadjuvant chemotherapy. 293 patients (86%) underwent surgery, of which 141 (48%) with minimally invasive surgery (MIS). 32 patients (11%) received postoperative (CRT) due to either deep stromal infiltration (n=8), metastatic lymph nodes (n=11), parametrial infiltration (n=5), positive margins (n=1) or a combination of several risk factors (n=5). 47 patients (14%) were treated with radical CRT. 40 patients (12%) developed recurrence, (13%) after surgery and 6% after CRT. 21 patients developed pelvic recurrence, 6 distant and 13 both local and distant. Most of the both local and distant recurrences (12 of 13) occurred in patients who had undergone MIS. There was only one pelvic failure after radical CRT. 3- and 5-year survival was 96% and 93%, respectively.
Conclusion Selection of patients based on MRI resulted in few patients who needed postoperative CRT and yielded excellent survival. However, the surgical technique warrants careful evaluation to reduce relapse rates.
Disclosure Nothing to disclose.
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