Oncological outcomes after radical hysterectomy followed by adjuvant (chemo)radiation or no further treatment in women with cervical cancer FIGO 2018 IB2-IIA2 – A multinational population-based cohort study

The role of adjuvant treatment after radical hysterectomy for early-stage cervical cancer with intermediate-risk factors remains uncertain. In this international population-based cohort study, we investigated the potential benefit of adjuvant treatment on overall survival (OS) and recurrence-free survival (RFS). Utilizing population-based registers from Sweden, Denmark, and the Netherlands, we included women with early-stage cervical cancer FIGO 2018 stages IB2-IIA2 with tumor size >20 mm and negative lymph nodes. All women underwent radical hysterectomy followed by either adjuvant radiotherapy or chemoradiotherapy (AT) or no further treatment (NFT). Survival outcomes were analyzed to assess the impact of AT. A total of 976 women with early-stage cervical cancer, treated between 2010 and 2017, were analyzed. At five years, there were no significant differences in OS (87.7 % vs. 91.9 %) or RFS (79.8 % vs. 82.6 %) between the AT (309 women, 32 %) and NFT (667 women, 68 %) groups. Selecting women with the intermediate risk factors: tumor size > =4cm or tumor size 2-3,9 cm with the presence of lymphovascular space invasion, no significant differences in OS or RFS were observed between AT and NFT. In addition, a multivariable analysis found that tumor size and lymphovascular space invasion predicted adverse survival outcomes. In this population-based cohort study, adjuvant therapy after radical hysterectomy was not associated with a survival benefit in women with FIGO 2018 IB2-IIA2 cervical cancer. These findings corroborate earlier findings on the role of adjuvant therapy for cervical cancer with intermediate-risk factors and support de-escalation to avoid radiation harm for this patient population.