Evaluation of efficacy and fertility after nonradical surgical therapy (extra fascial hysterectomy or cone biopsy, with pelvic lymphadenectomy) for stage IA1, IA2, and IB1 cervical cancer (GOG-0278)

Objective: To estimate the efficacy and perioperative morbidity of nonradical surgery (simple hysterectomy [SH] or cone biopsy [CB] plus pelvic lymphadenectomy [PLND] and to report pregnancy outcomes after CB. Methods: Prospective international study with 3-year follow-up of patients with stage IA1 (lymphovascular space invasion-positive) to IB1 (≤2 cm) cervical cancer stratified by fertility preservation (CB) or none (SH) (both with PLND). Criteria included ≤10 mm stromal invasion and negative margins on loop electrosurgical excision procedure or CB. Results: We enrolled 224 patients: 72 (32 %) CB and 152 (68 %) SH. Of those, 23 patients (5 CB; 18 SH) were deemed ineligible or refused surgery; 14 % had stage IA1, 28 % stage IA2, and 58 % stage IB1 disease; and 65 % had squamous carcinoma, 32 % adenocarcinoma, and 3 % adenosquamous carcinoma. We found adverse events (grade ≥ 3) within 30 days of surgery in 1 CB and 7 SH patients. In the CB group, 31 patients desired pregnancy during the study and 16 pregnancies occurred. Of those, 4 were spontaneous abortions, 3 were preterm deliveries, and 9 were full-term deliveries. After a median follow-up of 37 months (range 0.2-93 months), 3 patients in the CB group experienced recurrence (3-year recurrence-free survival, 94.8 %, and subsequently underwent hysterectomy), compared to none in the SH group. Conclusions: Non-radical surgery for early-stage cervical cancer appears safe, with low morbidity. Patients treated by CB and PLND can achieve successful pregnancies. Recurrences in the cervix after CB can occur and require diligent surveillance to attain high cure rates.