Intermediate Risk Cervical Cancer: Radical Surgery +/- Adjuvant Radiotherapy

Prior treatment

• Previous pelvic malignancy
• Previous pelvic radiotherapy
• Neoadjuvant chemotherapy prior surgical treatment

Other illness

• Adenosquamous cancer or adenocarcinoma unusual type (non-HPV related - such as: mucinous, clear cell, mesonephric) or other rare tumour types (those not listed in the inclusion criteria)
• Inconclusive primary site of disease

Age

• History of second primary cancer outside pelvis if ≤ 3 years complete clinical remission (CCR)

Other

• Unequivocally positive lymph node by imaging (by radiological subjective assessment)
• FIGO \<IB1 / \>IIA
• Low likelihood of patient compliance to the follow-up

• Pathologically confirmed invasive cervical cancer
• FIGO IB1-IIA
• Squamous cell cancer or HPV-related adenocarcinoma
• Presence of tumour-related risk factors as follows:
  • tumour ≥4 cm OR
  • tumour\>2 cm \<4 cm AND lymphovascular space invasion OR
  • tumour \>2 cm \<4 cm AND tumour free distance \<3 mm OR
  • tumour \>2 cm \<4 cm AND deep stromal invasion (\>2/3)
• No evidence of suspicious pelvic lymph nodes or distant metastases on imaging (by radiological subjective assessment before surgery and negative pelvic LN on final pathology)
• ECOG performance status 0-1
• Deemed suitable and fit for radical surgery followed by adjuvant radiotherapy
• Negative pregnancy test (if applicable)
• Negative HIV test (only performed in high-risk countries or patients who have moved from those countries within the past 10 years)