Intermediate Risk Cervical Cancer: Radical Surgery +/- Adjuvant Radiotherapy

Inclusion Criteria:

• Pathologically confirmed invasive cervical cancer
• FIGO IB1-IIA
• Squamous cell cancer or HPV-related adenocarcinoma
• Presence of tumour-related risk factors as follows:

1. tumour ≥4 cm OR
2. tumour>2 cm <4 cm AND lymphovascular space invasion OR
3. tumour >2 cm <4 cm AND tumour free distance <3 mm OR
4. tumour >2 cm <4 cm AND deep stromal invasion (>2/3)

• No evidence of suspicious pelvic lymph nodes or distant metastases on imaging (byradiological subjective assessment before surgery and negative pelvic LN on finalpathology)
• ECOG performance status 0-1
• Deemed suitable and fit for radical surgery followed by adjuvant radiotherapy
• Negative pregnancy test (if applicable)
• Negative HIV test (only performed in high-risk countries or patients who have movedfrom those countries within the past 10 years)

Exclusion Criteria:

• Adenosquamous cancer or adenocarcinoma unusual type (non-HPV related - such as:mucinous, clear cell, mesonephric) or other rare tumour types (those not listed in theinclusion criteria)
• Inconclusive primary site of disease
• Unequivocally positive lymph node by imaging (by radiological subjective assessment)
• FIGO <IB1 / >IIA
• Previous pelvic malignancy
• History of second primary cancer outside pelvis if ≤ 3 years complete clinicalremission (CCR)
• Previous pelvic radiotherapy
• Neoadjuvant chemotherapy prior surgical treatment
• Low likelihood of patient compliance to the follow-up