title: Primary management of early stage cervical cancer (IA1-IB) and appropriate selection of adjuvant therapy.
abstract: Cervical cancer is the third most common gynecologic malignancy in the United States but the leading gynecologic cancer worldwide. Most patients will present with clinical early-stage disease (International Federation of Gynecology and Obstetrics [FIGO] stage IA1-IB). These patients are a clinically heterogeneous group, and primary treatment can be either surgery or radiotherapy. Standard surgery is either radical hysterectomy with lymphadenectomy (stage IA2-IB2) or simple hysterectomy for microinvasive disease (stage IA1). Interest has been increasing in using conservative fertility-sparing surgery through radical trachelectomy as an option for select patients with early-stage disease who want future fertility. Primary radiotherapy is delivered as a combination of external-beam teletherapy and brachytherapy. It is given with concurrent cisplatin-based chemotherapy, based on 5 large randomized controlled trials that showed significant improvement in overall survival with the addition of chemotherapy. Using either radical surgery or radiation therapy in stage IB disease yields 5-year survival rates of 87% to 92%. The addition of postoperative adjuvant radiation with concurrent chemotherapy is recommended in patients with high- or intermediate-risk disease after radical hysterectomy to reduce risk for recurrence and improve progression-free survival. In select patients with stage IB2 disease with bulky tumors undergoing primary chemoradiation, adjuvant hysterectomy may provide benefit after treatment.
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Box 356460, University of Washington School of Medicine, Seattle, WA 98195, USA. hgray@u.washington.edu
authors.forename: Heidi J
authors.initials: HJ
authors.lastname: Gray
mesh_terms: D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007044:Hysterectomy; D009367:Neoplasm Staging; D018714:Radiotherapy, Adjuvant; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000628:therapy*