Clinical trial results could redefine cervical cancer treatment

Results from an international clinical trial involving UBC faculty of medicine researchers are poised to set a new standard of care for people with low-risk early-stage cervical cancer.

The findings, published in the New England Journal of Medicine, stem from the CX5/SHAPE trial comparing the current standard of care, radical hysterectomy, with a less invasive surgical intervention, simple hysterectomy.

The study concludes that the simpler approach is safe, effective and results in better quality of life for patients after surgery. 

“This trial will change the history of cervical cancer treatment worldwide, by allowing more individuals with cervical cancer to have less invasive surgery, without jeopardizing their survival outcomes,” said Dr. Janice Kwon, professor in UBC’s department of obstetrics and gynaecology, who led the study’s economic analysis. “This will translate into fewer side effects for patients, and less cost to the health care system.”

Although radical hysterectomy is a highly effective treatment, it comes with a higher risk of long-term surgical side effects including compromised bladder, bowel and sexual function.

The trial results show that patients who received a simple hysterectomy saw fewer bladder injuries, ureteral injuries and adverse events within four weeks of surgery. In addition, patients who received a simple hysterectomy had an overall better quality of life after treatment with fewer negative impacts on their sexual health. 

“For individuals receiving treatment for cervical cancer, preserving overall quality of life and sexual health is deeply important. This research highlights that a simple hysterectomy has fewer negative effects on sexual health and life quality, while not compromising on the integrity of treatment, cancer recurrence and survival outcomes,” said Dr. Lori Brotto, a professor of obstetrics and gynaecology at UBC and executive director of the Women’s Health Research Institute, who led on the analysis of sexual health and quality of life outcomes.

This study has potential implications in parts of the world where cervical cancer is endemic. According to the World Health Organization, cervical cancer is the fourth most common cancer in women globally, and unfortunately more common in less affluent countries.  

“The global impact of these results is important to note as surgical de-escalation may allow women in low and middle-income countries easier access to less radical surgical interventions,” says Dr. Lois Shepherd, professor of pathology and laboratory medicine at Queen’s University and one of the CX5 investigators.

Led by the Canadian Cancer Trials Group (CCTG), the CX5/SHAPE study involved 700 women with low-risk early-stage cervical cancer from 12 different countries. The study was funded directly by the Canadian Institutes of Health Research (CIHR) and in part by the Canadian Cancer Society (CCS).