TWO STUDIES reported in The New England Journal of Medicine1,2 showed that patients with early-stage cervical cancer had reduced disease-free and overall survival when treated with minimally invasive radical hysterectomy vs open or radical hysterectomy. The findings of these studies have been widely reported by major media, including The New York Times, TIME, CNN, and NPR.
Consequently, many patients know about these studies and have lots of questions to ask. “It is truly a great relationship when patients come in with the ability to ask really important questions like this,” David E. Cohn, MD, told The ASCO Post. “It brings the standards of medicine to where they should be, knowing that patients have the information to lead them to challenge a physician and his or her decision about a proposed pathway, in terms of, for example, minimally invasive vs open surgery.” Dr. Cohn is Chief Medical Officer, Arthur G. James Cancer Hospital and Solove Research Institute, and Professor and Director, Division of Gynecologic Oncology, The Ohio State University, Columbus.
Counseling Patients About Risks and Expected Outcomes
THE INFORMATION reported “is critically important in being able to counsel our patients about the risks and expected outcomes of minimally invasive surgery vs open surgery for cervical cancer,” Dr. Cohn stated. For Dr. Cohn and many other gynecologists, those discussions started back when the data were first presented at the 2018 Society of Gynecologic Oncology (SGO) Annual Meeting in March. A dedicated session on emerging data is planned for the 2019 SGO Annual Meeting (March 16–19, 2019, Honolulu).
For patients requiring treatment for early-stage cervical cancer, an explanation of the study data and the implications should “absolutely be part of the upfront physician-patient discussion,” Dr. Cohn said. For women previously treated “with minimally invasive surgery as the appropriate procedure, there is nothing that results from” the recently published studies “that would lead a clinician to recommend any adjuvant treatment or different follow-up compared with the standard,” he advised.
Other Treatment Options
ALTHOUGH THE studies focused on surgery for early-stage cervical cancer, “every woman who has cervical cancer has the option for radiation therapy with or without chemotherapy as a suitable treatment,” Dr. Cohn said.
“There are some distinct advantages to surgery compared with radiation,” he noted. One is that “ovarian function can be preserved if you don’t radiate the patient and you just do a hysterectomy without removing the ovaries.” In addition, “sexual function is preserved, because radiation therapy may reduce satisfactory sexual intercourse.” According to Dr. Cohn, those two factors indicate that many younger patients typically may undergo surgery over radiation therapy.
“You are trading the short-term complications of surgery for the long-term complications of radiotherapy, which may affect the urinary or gastrointestinal system.” Conversely, “a 70-year-old patient who has poor cardiac function certainly will undergo radiation therapy, as the short-term risks would be far worse than the long-term ones.”
The rates of surgery and radiation therapy vary by institution, but “overall, most patients end up having surgery for their early-stage cervical cancer,” Dr. Cohn said. However, women with higher-stage disease generally receive radiochemotherapy, he added. “Primary radical hysterectomy is not an option for the patient population beyond stage IIA,” he noted. ■
DISCLOSURE: Dr. Cohn is a consultant for Oncology Analytics, Inc. and has received institutional funding from Agenus, Ajinomoto, Array BioPharma, AstraZeneca, Bristol-Myers Squibb, Clovis Oncology, Ergomed, Exelixis, Genentech, GlaxoSmithKline, Gynecologic Oncology Group, ImmunoGen, INC Research, inVentiv Health Clinical, Janssen Research and Development, Ludwig Institute for Cancer Research, Novartis, PRA International, Regeneron Pharmaceuticals, Serono, Stemcentrx, Tesaro, Tracon Pharmaceuticals, AbbVie, Henry Jackson Foundation, Pharma Mar, Sanofi, EMD Serono, Eisai, Pfizer, and Advaxis.
1. Ramirez PT, Frumovitz M, Pareja R, et al: Minimally invasive versus abdominal radical hysterectomy for cervical cancer. N Engl J Med 379:1895-1904, 2018.
2. Melamed A, Margul DJ, Chen L, et al: Survival after minimally invasive radical hysterectomy for early-stage cervical cancer. N Engl J Med 379:1905-1914, 2018.