Utilization of Hysterectomy Following Chemoradiation for IB2/IIA2 Cervical Cancer in the National Cancer Data Base

Background/Aim: Performing hysterectomy following chemoradiotherapy (CRT) for IB2/IIA2 cervical cancer is highly controversial. This study evaluated national practice patterns in utilization of post-CRT hysterectomy in the United States compared to CRT alone, as well as outcomes. Materials and Methods: The National Cancer Database was queried for patients with newly diagnosed IB2111A2 cervical cancer. Multivariable logistic regression analysis assessing factors predictive of undergoing post-CRT hysterectomy. Kaplan-Meier analysis evaluated overall survival (OS) and Cox proportional hazards modeling determined variables associated with OS. Results: Altogether, 1,691 patients met the inclusion criteria; 1,551 (92%) received CRT alone, and 140 (8%) underwent subsequent hysterectomy. Patients with tumors >= 8 cm were more likely to undergo hysterectomy. Patients who underwent additional hysterectomy, likely a higher-risk cohort, displayed OS comparable to those receiving CRT alone. Conclusion: Greater tumor size was associated with hysterectomy following CRT for IB2/IIA2 cervical cancer in the United States. These patients achieve OS comparable to those receiving standard-of-care CRT.