How would you treat a woman who has had a simple, extrafascial hysterectomy for a clinically occult, pathologically FIGO stage IB1 cervical cancer?

Standard would be to do some form of radical hysterectomy and if not done add adjuvant RT.

That being said, the absolute risk of parametrial involvement for that size of disease is very low, and the benefit of RT if at all, is very small and requires a discussion of the pros and cons of intervention.

GOG single arm prospective study (NCT01649089) is looking at QOL and recurrence pattern with simple hysterectomy and nodal assessment like this case in IB1 or less cervical cancer.

Agree with Dr. @Dr. First Last.

Only additional thought, 4 mm cervical stromal invasion out of how many mm total thickness? Some cervical stromas are 5-6 mm thick, others are 15 mm thick.

If the patient had a small cervix and therefore a deep 1/3 stromal invasion, then she'd meet Sedlis criteria and I'd proceed with RT and not even offer the completion surgery.

If the patient wants to skip RT, then I'd send her back for the completion surgery.

She can opt for surveillance alone at this point but that would not be a recommended option.

Treating adjuvantly now will be much less of a problem than treating recurrent disease in the parametria.

Multiple trials pending in this space (rad hyst vs simple hyst) besides GOG 278 mentioned above:

This one (all...