The ConCerv trial investigated whether more conservative, smaller surgeries were effective women with early stage, low risk cervical cancers. This study was undertaken as the radical surgery for early stage cervical cancer is very effective, but can carry significant side effects. It found that in carefully selected women, conservative surgery by either cone biopsy or simple hysterectomy, both with lymph node assessment, had low rates of recurrence and may be considered a safe option.
Trial description
The ConCerv trial was a prospective study that assessed and followed the clinical information and outcomes of 100 women with early stage, low risk cervical cancers. This trial included only cervical tumours less than 2cm in size, and without any evidence of spread outside the cervix. These women were either treated with removal of a large portion of their cervix (a cone biopsy), or a simple hysterectomy (surgical removal of the womb, but less extensive a surgery than the radical hysterectomy usually offered). They all underwent surgery to sample their pelvic lymph nodes. The women were assessed every 3 months for any sign of the cancer coming back over the course of two years at minimum. The average length of time of follow up was 36 months.
Almost half of the women (44) wished to retain the possibility of childbearing and underwent removal of a large portion of their cervix and lymph node assessment, but preservation of their womb. Forty women underwent a cone biopsy followed by a simple hysterectomy and lymph node assessment. Sixteen women were only diagnosed with a cervical cancer when the lab scientist was examining their cervix after having had their hysterectomy for another reason. These women went on to have a sampling of their lymph nodes at a second surgery.
Outcome
Women who had a cone biopsy and no disease in their lymph nodes had low rates of the cancer coming back (1 of 42 women, 2.4%) Women who had a cone biopsy that had completely removed the cervical cancer, and then went on to have a simple hysterectomy and lymph node sampling (with no disease in their lymph nodes) had no cancer come back over the course of follow up (0 of 36 women, 0%). Women who had their cancer diagnosed only after their hysterectomy had been performed had a higher rate of the cancer coming back. None of these women had disease affecting their lymph nodes at their second surgery but the cancer came back for 2 of 16 women (12.5%) in this group.
Conclusion
Conservative surgery by either cone biopsy or simple hysterectomy, both with lymph node assessment, may be a safe option for carefully selected women with early stage, low risk cervical cancers.
More research is needed into the best management for women who have their cancer diagnosed only following hysterectomy.
