The efficacy of long term follow-up and CO2 laser conization as conservative management in patients with cervical cancer stage FIGO IA1

Abstract

Background: Patients with FIGO (International Federation of Gynaecologists and Obstetricians) stage IA1 cervical squamous carcinoma can be treated conservatively with conization only as alternative to a hysterectomy. The aim of this study was to evaluate the efficacy of laser CO 2 excision as therapeutical method for stage IA1 cervical squamous carcinoma. Methods: Sixty patients were submitted to CO 2 laser conization with histologic diagnosis of squamous carcinoma stage FIGO IA1 and then submitted to follow-up with PAP smear, colposcopy and biopsy. Prognostic risk factors for relapse were evaluated with univariate analysis. Results: Conservative management with laser therapy was effective in more than 90% of the patients. When disease persistence was detected (7%), patients underwent repeated laser CO 2 conization and followed-up without demolitive intervention. The risk of disease progression in the case series was 1.8%. Univariate analysis revealed that only depth of stromal invasion was a significant risk factor for relapse (P<0.04). Moreover, depth of stromal invasion between 1-3 mm was the only prognostic factor for relapse with specificity 78%, sensitivity 75% and likelihood positive ratio 3,47. Conclusion: Laser CO 2 conization alone appeared to be an effective and safe treatment for patients with Cervical Cancer Stage FIGO IA1 if careful post-treatment follow-up was guaranteed. The deph of stromal invasion has been confirmed as the most important risk and prognostic factor to be evaluated for disease relapse.