SHAPE (CCTG CX.5)

Radical hysterectomy removes the parametrial tissue and upper vagina along with the uterus and carries lasting urinary, bowel and sexual side effects. SHAPE, run by the Canadian Cancer Trials Group with the Gynecologic Cancer InterGroup, randomised 700 women with low-risk early cervical cancer (2 cm or less, less than 10 mm of stromal invasion, no node involvement on imaging) to simple or radical hysterectomy, both with pelvic node assessment. The primary endpoint was pelvic recurrence at three years, tested for non-inferiority.

Pelvic recurrence at three years was low and non-inferior with simple hysterectomy, and urinary incontinence and retention were less frequent. The result, published in the New England Journal of Medicine in 2024, made simple hysterectomy a standard for this carefully defined low-risk group and reversed the trend towards ever more radical surgery.