Experts Recommend Open vs Minimally Invasive Radical Hysterectomy for Cervical Cancer

Findings from a phase 3 study have led investigators to assert that gynecologic oncologists recommend open radical hysterectomy to their patients with early stage cervical cancer (Lancet Oncol. 2020 June 1. Epub ahead of print).

“In the phase 3 LACC trial and a subsequent population-level review, minimally invasive radical hysterectomy was shown to be associated with worse disease-free survival and higher recurrence rates than was open radical hysterectomy in patients with early stage cervical cancer,” wrote lead investigator Michael Frumovitz, MD, Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, and colleagues, who now report quality of life findings—a secondary end point—of the study.

A total of 631 patients with stage IA1 with lymphovascular space invasion, IA2, or IB1 adenocarcinoma, squamous cell carcinoma, or adenosquamous carcinoma of the cervix were enrolled in the open-label, non-inferiority LACC trial at 33 centers across the globe. These patients were randomized in a 1:1 ratio to undergo open (n = 312) or minimally invasive (n = 319) radical hysterectomy.

The primary and secondary end points were disease-free survival at 4.5 years and quality of life. Validated quality-of-life and symptom assessments (ie, 12-item Short Form Health Survey, Functional Assessment of Cancer Therapy–Cervical [FACT-Cx], EuroQoL-5D, and MD Anderson Symptom Inventory) were given to eligible patients before surgery and at 1 and 6 weeks and 3 and 6 months post-surgery. Patients were also given FACT-Cx at additional timepoints up to 54 months post-surgery.

Dr Frumovitz et al evaluated differences in quality of life over time between the 2 treatment arms via the modified intention-to-treat population (ie, all patients who had surgery and completed at least 1 baseline and 1 follow-up questionnaire).

Overall, 496 (79%) patients were included in the modified intention-to-treat analysis (244 [78%] in the open surgery arm and 252 [79%] in the minimally invasive surgery arm). Follow-up lasted for a median of 3.0 years.

There were no differences observed in the mean FACT-Cx total score between the open surgery (129.3) and minimally invasive surgery (129.8) arms at baseline. Six weeks post-surgery, no differences in mean FACT-Cx total scores were identified between the groups (128.7 in the open surgery arm vs 130.0 in the minimally invasive surgery arm); the same was observed 3 months post-surgery (132.0 vs 133.0, respectfully).

“Since recurrence rates are higher and disease-free survival is lower for minimally invasive radical hysterectomy than for open surgery, and postoperative quality of life is similar between the treatment groups, gynaecological oncologists should recommend open radical hysterectomy for patients with early stage cervical cancer,” Dr Frumovitz and colleagues concluded.—Hina Porcelli