Treatment of Stage I/IIA

Surgical Options by Stage

  • CIS: Conization can be done for young patients with CIS.
  • IA1: Extrafascial Hysterectomy (Type I)
  • IA2: Radical Hysterectomy (Type III) + Pelvic Lymph Node Dissection +/- paraaortic lymph node sampling.
  • IB1:
    • Radical hysterectomy + pelvic lymph node dissection + paraaortic lymph node sampling (category 1)
    • Pelvic RT + brachytherapy (point A dose: 80-85 Gy)

Surgery vs. Radiation

  • Controversy: Survival is equivalent in early stage cervical CA to RT.
  • Two prospective randomized trial comparing surgery to RT:

Roddick (Kentucky) 1971:

  • 100 patients with all stages randomized to RT (7000 rads) versus RH.
  • RT was more successful in later stages II or greater.

Newton (Chicago) 1975:

  • 119 stage I patients randomized to RH versus XRT
  • 5 year survivals were nearly equivalent at 81% to 74%(XRT).

Landoni (Italy) Lancet 350:535-40, 1997.

  • 343 stage IB or IIA pts (mostly IB) randomized to RH versus XRT
  • equal OS (83%) and DFS (74%)
  • post-op RT required for 108/169 surgery patients.
  • Severe morbidity higher with surgery group 28% vs 12%.

Advantages of surgery:

  • No risk of secondary malignancy
  • Vaginal/sexual function better than RT
  • Ovarian function preserved
  • Short duration of treatment
  • Pathologic staging
  • Avoid late RT complications
  • Avoid irradiation in presence of PID (increased risk of SBO)

Complications

  • blood loss
  • fistulas
  • PE
  • SBO
  • operative mortality
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