Radical Hysterectomy: Excessive Treatment for Low-Volume Stage IB1 Cervical Cancer

Objective: The purpose of this study was to identify a subset of patients with low volume stage IB1 cervical cancer who may benefit from simple hysterectomy as opposed to conventional radical hysterectomy. Design: This study was designed as a retrospective review. Setting: The study took place at the West of Scotland Gynaecological Cancer Centre. Population: The study population was a total of 90 patients with stage IB1 cervical cancer. Methods: A case note review of patients who underwent radical hysterectomy over 7 consecutive years from April 2001 to April 2008 was performed. Following diagnostic large loop excision of the transformation zone (LLETZ), tumor volume was assessed by multiplying length x width x depth measurements. Volumes above the cutoff value of 500mm(3) were considered to be significant tumor volume (STV) and those below this value were considered to be nonsignificant tumor volume (NSTV). Tumors that were macroscopically evident were regarded as STV, and only punch biopsies were taken. Results: The median tumor dimensions in patients who underwent LLETZ biopsy were: 11.79mm length, 6.67mm width and 6.52mm depth. There were 51 (56%) patients in the STV group. Within this group, 14 (27%) had parametrial involvement and 7 (14%) had vaginal involvement. There were 39 (44%) cases in the NSTV group and none had parametrial or vaginal involvement (p < 0.001 and p = 0.01, respectively). Among the patients with STV, 42 (82%) had residual disease as opposed to only 10 (25%) patients in the NSTV group (p < 0.0005). The median follow- up period was 35 months (range 1- 85). There were only 3 (3%) recurrences in total, all of which were within the STV group. Conclusions: The data from this study support the current growing opinion that radical hysterectomy can be regarded as overtreatment for selected cervical cancer patients with low volume disease.