In light of the SHAPE trial results, how would you manage a patient with an incidentally diagnosed FIGO IA1 cervical cancer after simple extrafascial hysterectomy/BSO?

Without question, I would recommend that this patient receive pelvic RT and probably cuff brachytherapy as well. The SHAPE trial (NCT01658930) enrolled "low risk" patients, but they allowed LVSI patients into the trial, even though this is a high risk feature for local recurrence. There were approximately 10% of patients who were reported to have LVSI, and, interestingly, that was approximately the percentage of patients who received adjuvant treatment with pelvic RT +/- chemo. In other words, the use of adjuvant treatment was not controlled in the study and was most likely given to the LVSI patients, as I cannot see another indication. The appropriate treatment would either be adjuvant RT or completion surgery to include parametrectomy and...

If one uses the mm diagnosis of Stage IA cancer (the previous FIGO staging) then there is a ton of data that shows that hysterectomy is adequate therapy.