12
Treatment
Note With risk factors on
patholog y specimen:
adjuvant chemotherapy
aer hysterectomy (Sedlis
et al. criteria
g
used in
United States)
(EB/CB, In, W)
With risk factors on patholog y
specimen: adjuvant RT
± chemotherapy aer
hysterectomy
Adjuvant RT (intermediate
risk) or with concurrent
low-dose platinum-based
chemotherapy (high risk) in a
referral center
Wherever radical hysterectomy
with concurrent chemoRT
listed as a surgical option above,
extrafascial hysterectomy
is recommended if there is
residual disease aer RT or
chemoRT with a boost of 68 Gy
or initial tumor >6 cm
Radical hysterectomy may be
used aer RT or chemoRT to a
dose of 50 Gy
(EB/CB, L, W)
IIA1 See IB1 See IB1
IIA2 See IB2 See IB2
NOTE. Bold indicates addition of a recommended action over a previous resource level (eg, in
limited setting, a bold action is one that was not recommended in basic).
a
is option in basic level only if follow-up is available.
b
For negative margins or operable tumor or positive margins for dysplasia or carcinoma.
c
For negative margins or inoperable tumor.
Table 3. Recommendations for Stage IA, IB, and IIA Disease
(cont'd)
Type of Disease Basic Limited
Table 3a. Combination of Three Risk Factors: CLS, Stromal
Invasion, and Tumor Size by Treatment Regimen
CLS
a
Stromal Invasion Tumor size (cm)
Positive Deep one-third Any
Positive Middle one-third ≥2
Negative Deep or middle one-third ≥4
Positive Superficial one-third ≥5
Total
a
CLS, capillary lymphatic space.
Data adapted with permission from Sedlis A, et al. Gynecol Oncol. 73:177-183, 1999.
