Home Medizin Nicht-radikale Chirurgie ist eine Win-Win-Situation bei Gebärmutterhalskrebs im Frühstadium

Nicht-radikale Chirurgie ist eine Win-Win-Situation bei Gebärmutterhalskrebs im Frühstadium

von NFI Redaktion

The results of the GOG-278 study suggest that in early-stage cervical cancer, a non-radical surgery (simple hysterectomy or cone biopsy plus pelvic lymphadenectomy) appears to be safe and does not have any long-term negative impact on quality of life.

Indeed, the quality of life of patients improved in both groups after surgery, and their concerns regarding cancer recurrence decreased, especially in patients who underwent a simple hysterectomy, as stated by Dr. Allan Covens in his recent abstract presentation at the Society of Gynecologic Oncology (SGO) Annual Meeting 2024 on Women’s Cancer on March 17, 2024.

„Patients who underwent cone biopsy reported fewer concerns regarding reproductive fertility post-surgery compared to preoperative assessments, both immediately after the operation and over time,“ he added.

With screening programs in developed countries detecting a large portion of cervical cancer cases at an early stage, treating these types of cancers with a radical operation leads to high cure rates but significant negative effects on quality of life, said Covens from the University of Toronto, Toronto, Ontario, Canada.

He and his colleagues sought to determine if a non-radical operation could be safely employed instead. „Several case series have shown that a non-radical operation is associated with lower morbidity and improved quality of life,“ he explained. „If this can be proven in a prospective assessment, it will change future practice.“

Allan Covens, MD

„Several case series have shown that a non-radical operation is associated with lower morbidity and improved quality of life. If this can be proven in a prospective assessment, it will change future practice.“

GOG-278 was a prospective cohort study with women with stage IA1 (lymphovascular space invasion +) and IA2-IB1 (≤ 2 cm) cervical cancer who underwent a non-radical operation (simple hysterectomy or fertility-preserving cone biopsy) plus pelvic lymphadenectomy. Criteria included stromal invasion ≤ 10 mm and negative margins on the final cone biopsy.

The main objectives were to assess changes in functional quality of life outcomes (bladder/bowel function, sexual function, cancer worries, and reproductive issues) using validated instruments. The results were based on 55 patients who underwent cone biopsy and 113 who underwent simple hysterectomy.

Both simple hysterectomy and cone biopsy were associated with „mild“ decreases in sexual function and bladder/bowel function 4 to 6 weeks after surgery, but function recovered „rapidly“ back to baseline after 6 months, Covens reported.

Twelve patients reported a diagnosis of lymphedema with a change in the Gynecologic Cancer Lymphedema Questionnaire score of 4 or higher in at least two consecutive assessments compared to baseline. This occurred in six cone biopsy patients and six simple hysterectomy patients.

In a separate presentation, Covens reported on secondary oncologic outcomes from GOG-278, indicating that a non-radical operation in early-stage cervical cancer is safe with low perioperative morbidity, although longer-term follow-up is necessary.

He also reported on 16 pregnancies in 15 patients who underwent cone biopsy; 12 of these were successful, with four early pregnancy losses.

„Impressive“ Data

Discussant Kristin Bixel from Ohio State University in Columbus, Ohio, remarked that the data were „impressive“ and clearly showed that a non-radical operation „has minimal impact on bladder/bowel function, without long-term differences from baseline.“

She noted that the incidence of lymphedema was „honestly significantly lower than what I typically advise patients“ and questioned whether the percentage of patients with lymphedema would increase over time.

Bixel specifically highlighted the decrease in cancer worry scores post-operation, as patients opting for less radical procedures sometimes fear an increased risk of cancer recurrence.

The „growing body of evidence suggests that a less radical operation in early-stage cervical cancer is safe and effective with low risk, emphasizing potential reproductive success,“ she concluded.

The study was funded by grants from NRG Oncology. Covens did not disclose any relationships. Bixel has received research funding from the Intuitive Foundation.

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