Primary Management of Early Stage Cervical Cancer (IA1-IB) and Appropriate Selection of Adjuvant Therapy

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.