Introduction Optimal treatment of bulky stage IB cervical cancer has long been a source of controversy. Definitive chemoradiation therapy (chemoRT) has been the preferred approach for large IB disease, however the role of post-radiation surgery has not been fully defined. The objective of the study was to compare the recurrence, complication, and survival data between patients with large primary cervical lesions undergoing definitive chemoRT with post-radiation surgery.

Methods Retrospective cohort analysis of patients at a single institution with IB cervical cancer and primary lesions greater than 4 centimeters treated between January 1st, 2008 and December 31^st, 2016. Data was extracted from patient’s electronic or paper medical records. Data variables included patient demographics, comorbidities, oncologic treatments, complications, and survival. The Kaplan-Meier method was used to estimate recurrence-free survival and overall survival censored at 5 years and the log-rank test provided a statistical comparison between chemoradiation and post-radiation hysterectomy.

Results 42 patients were identified: 16 receiving chemoRT (Arm A) and 26 receiving post-radiation hysterectomy (Arm B). Demographics, comorbidities, and tumor characteristics were comparable between groups, with a majority of patients identified as stage IB2. Rates of treatment-related complications requiring hospitalization were low in both groups: Arm A (25%) vs Arm B (15.4%) (p=0.45). 5-year recurrence-free survival was comparable between both groups (62.5% vs 73%, p= 0.52) and overall survival censored at 5 years in the post-radiation hysterectomy was more favorable although not statistically significant (68.75% vs 88.5%, p= 0.17).

Conclusion/Implications Post-radiation hysterectomy, while safe in terms of long-term morbidity, did not confer a significant survival advantage.