Good outcomes with conservative management of stage IB1 cervical cancer

August 9, 2007

NEW YORK (Reuters Health) - Conservative surgical management of small-volume stage IB1 cervical cancer provides excellent outcomes, according to findings published in the August issue of BJOG: An International Journal of Obstetrics and Gynaecology.

"This is a more sophisticated approach to management of small-volume disease," Dr. Raj Naik from Queen Elizabeth Hospital, Gateshead, UK told Reuters Health. "We need to determine management based on tumor volume estimations rather than crude FIGO staging."

Dr. Naik and colleagues investigated outcomes of 17 women with small-volume stage IB1 cervical cancer who were managed by conservative surgical treatment.

Twelve women underwent laparoscopic assisted vaginal hysterectomy/total abdominal hysterectomy with or without pelvic lymph node dissection, the authors report, and five women (four nulliparous) underwent fertility-sparing treatment (loop cone with or without laparoscopic pelvic node dissection).

There were no cases of residual disease, the investigators say, and there were no cases of metastatic spread to pelvic lymph nodes.

During follow-up ranging from 9 to 66 months (median, 29 months), no patients developed recurrent disease, and all of the women were alive and well at last follow-up.

There were no major perioperative complications, the researchers note, though one woman developed lower limb lymphedema, one woman developed a pelvic lymphocyst, and another woman underwent bilateral salpingo-oophorectomy for a benign ovarian cyst during follow-up.

"A more formal assessment of tumor volume with a more active approach to determining the third dimension will allow more women the option of conservative treatment, thereby minimizing the adverse effects of radical surgery," the authors conclude.

Dr. Naik said more studies are planned to "produce larger series with longer follow-up (and to) develop better methods of determining tumor volume and multi-focality."

Radical surgery might still be performed if volume measurements are uncertain and if that is the patient's preference, the researcher added.