Abstract
BackgroundThere are currently three ongoing studies on less radical surgery in cervical cancer: ConCerv, GOG-278, and SHAPE. The aim of this study was to evaluate the performance of the criteria used in ongoing studies retrospectively and suggest a new, simplified criterion in microscopic Stage IB1 cervical cancer.MethodsA retrospective analysis was performed in 125 Stage IB1 cervical cancer patients who had no clinically visible lesions and were allotted based on microscopic findings after conization. All patients had magnetic resonance imaging (MRI) after conization and underwent type C2 radical hysterectomy. We suggested an MRI criterion for less radical surgery candidates as patients who had no demonstrable lesions on MRI. The rates of parametrial involvement (PMI) were estimated for patients that satisfied the inclusion criteria for ongoing studies and the MRI criterion.ResultsThe rate of pathologic PMI was 5.6% (7/125) in the study population. ConCerv and GOG-278 identified 11 (8.8%) and 14 (11.2%) patients, respectively, as less radical surgery candidates, and there were no false negative cases. SHAPE and MRI criteria identified 78 (62.4%) and 74 (59.2%) patients, respectively, as less radical surgery candidates; 67 patients were identified as less radical surgery candidates by both sets of criteria. Of these 67 patients, only one had pathologic PMI with tumor emboli.ConclusionsThis study suggests that the criteria used in three ongoing studies and a new, simplified criterion using MRI can identify candidates for less radical surgery with acceptable false negativity in microscopic Stage IB1 disease.
Highlights
There are currently three ongoing studies on less radical surgery in cervical cancer: ConCerv, Gynecologic Oncology Group protocol 278 (GOG-278), and SHAPE
The aim of this study was to evaluate whether the criteria used in three ongoing studies accurately identified low-risk patients for parametrial involvement (PMI) with acceptable false negativity, and to suggest a new, simplified criterion using magnetic resonance imaging (MRI) findings in microscopic Stage IB1 cervical cancer
We suggested a new, simplified criterion for less radical surgery as patients with no demonstrable lesions on post-conization MRI in microscopic Stage IB1 cervical cancer
Summary
There are currently three ongoing studies on less radical surgery in cervical cancer: ConCerv, GOG-278, and SHAPE. Two prospective cohort studies and one randomized controlled trial are evaluating less radical surgery (conization or simple hysterectomy) in patients with lowrisk early-stage cervical cancer [10]. The MD Anderson Cancer Center is conducting a prospective, international, multi-institutional cohort study (ConCerv) evaluating the safety and feasibility of conservative surgery in women with early-stage cervical cancer [11]. The third is the Gynecologic Cancer Intergroup trial by Plante and colleagues, known as the SHAPE trial. This is a randomized controlled trial comparing the outcomes of radical hysterectomy and simple hysterectomy in patients with low-risk cervical cancer [13]. JCOG-1101 was not considered in this study as they permitted some extent of parametrectomy
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