Is there a role for chemotherapy and/or vaginal cuff boost to EBRT in FIGO IB1 cervical adenocarcinoma, status post total hysterectomy?

Recently presented SHAPE trial shows non-inferiority of simple hysterectomy to radical for IB1 disease or lower disease.

So for the above patient, that may not change anything but certainly would need nodal assessment which could be from surgery or RT after PETCT.

Re-analysis of prior GOG studies to identify histology-specific factors for recurrence can also guide adjuvant therapy decisions in surgically staged patients.

Levinson et al., PMID 34217544

As @Dr. First Last noted, if only hysterectomy was performed and nodes weren't assessed, there is still some...

If the patient had IB1 disease, but no other Sedlis or Peters for chemoRT indications, I would not recommend chemotherapy. Because of simple Hys EBRT could be considered, as ideally patient should have received modified rad hys.

In regards to brachytherapy post EBRT - this is a more nuanced questio...

I disfavor chemotherapy in this scenario and would utilize EBRT with an HDR brachytherapy boost or at the least brachytherapy alone. The patient likely had surgery performed by a non-Gyn Oncologist without cancer considerations. Brachytherapy in post-op cervical therapy is relatively well tolerated ...

We have added concurrent chemotherapy for path IB2 patients s/p total hysterectomy but I would not add it for an IB1 given SHAPE trial. Given non-oncologic resection for cervical cancer (assuming no nodal staging), I would at least recommend EBRT + brachytherapy boost in this scenario.