Study data supports less radical cervical cancer surgery alternative

Editor's Note

New research supports fertility preservation with cone biopsy as a viable, less radical option for to surgery in patients with early, low-risk cervical cancer, according to a report published March 18 in MedPage Today.

Presented at the Society of Gynecologic Oncology annual meeting, the findings from the Gynecologic Oncology Group (GOG)-278 trial showed in patients with stage IA1 (with lymphovascular invasion) to stage IB1 disease, extrafascial hysterectomy or cone biopsy with lymphadenectomy led to no changes in bowel function, the article says citing testimony from Allan Covens, MD, of the University of Toronto and Sunnybrook Health Sciences Center. Additionally, declines in sexual function and bladder function at 4 to 6 weeks after surgery generally recovered to baseline levels by 6 months.

However, the study also identified a small risk of disease recurrence, with three of the 203 GOG-278 patients eligible for survival analysis, all in the cone-biopsy group, had a cancer recurrence after median follow-up of 37 months.

Of the 31 patients who wanted to become pregnant during the prospective study, 15 conceived after the cone biopsy plus lymphadenectomy procedure. Of that group, three delivered preterm, nine went to term, and four had spontaneous abortions, MedPage reports. According to testimony from Covens, quality of life improved and worries about cancer recurrence decreased after surgery in both groups.

“Radical surgery for early cervical cancer has high cure rates but can result in major complications,” the article notes. “For example, one of the most challenging parts of the radical approach—removal of the fat and connective tissue that surrounds the uterus—can lead to blood loss, fistula formation, and bladder, bowel, and sexual dysfunction.”

The full MedPage report also sheds light on a growing body of other data supporting the effectiveness of less-radical interventions for early-stage, low-risk cervical cancer, such as the ConCerv and SHAPE trials.