1. Vivek Nama UHBT

2. Surgical staging: Tumour grade Myometrial invasion Lymphovascular space involvement Cervical stromal invasion Spread to regional lymphnodes Decreased survival

3. Evidence at its best- ASTEC trial Factorial design 700 patients Panici Trial 300 patients Recurrence rates are low – sample size

4. Balance Surgery Radiother apy

5. What outcomes? Survival Quality of life Cost

6. Total Cases 335 Cases included 278 FIGO Stage 1A 184 FIGO Stage 1B 52 FIGO Stage 2 42 Sarcomas 12 No Surgery 17 FIGO Stage > 2 28

7. Lymphnode Involvement:

8. ProcedurePer Unit CostAll Grades (n=278)Grade 2 &3 (n=162) EBRT+VBT£7,823.74£ 618,075.46 (n=79) Lymphadenectomy£1,000.00£ 278,000 (n=278)£ 162,000 (n=162) Lymphnode positive (EBRT) (Lymphnode positivity as 5.35%, SEER data) £ 74,592 (n=14.38) £ 46,177.7 (n=8.6)+£ 46,942.44 (n=6 from G1) = £ 93120.14 VBT only£2,495.76£ 187,182 (n=75)£ 184,686.24 (n=74) Cost Savings£ 78,301£ 178,268.52 Cost Savings/100 patients £ 28,057£ 110,042.59

9. EBRT prevented: All Grades – 26.98 % 75 of the 79 (94.43%) Grade 2 and 3 cancers 40.74% of all patients needing EBRT 66 cases of the total 71 (92.95%)

10. Quality of Life? Quality of Life and Symptoms ScalesSig.* 1The medians of Age are the same across categories of treatment..572 2The medians of Urinary score are the same across categories of treatment..328 3The medians of Global Health score are the same across categories of treatment..004 4 The medians of Physical functioning score are the same across categories of treatment..356 5The medians of Bowel score are the same across categories of treatment..154 6The medians of Fatigue final score are the same across categories of treatment..058 7 The medians of Nausea and vomiting score are the same across categories of treatment..638 8The medians of Pain score are the same across categories of treatment..020

11. Trial Primary Outcome: Quality of life Cost Secondary Outcome: Disease free survival Overall Survival

12. Service Evaluation Pre Treatment Standard Treatment Follow up QLQC – 30/EN 24

13. How to Collect Paper Based Web Based Iphone/Ipad based

15. Analysis: Quality of life based on EORTC manual Overall Survival Disease Free Survival Cost

16. Next Steps: PPI – Moving on day Surgical Trials unit Funding for administrator Web based platform