What are the ASCO guidelines for treating invasive cervical cancer?

Updated: Feb 12, 2019
  • Author: Cecelia H Boardman, MD; Chief Editor: Warner K Huh, MD  more...
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In 2016, the American Society of Clinical Oncology (ASCO) issued its first clinical practice guideline on invasive cervical cancer. The guideline is "resource-stratified," and gives treatment recommendations that are tailored to the availability of healthcare resources in specific regions. [110, 111] :

Some of the key recommendations are:

  • In basic settings, where radiation therapy is not an option, extrafascial hysterectomy, either alone or after chemotherapy, can be an option for women with stage IA1 to IVA cervical cancer.
  • Concurrent radiotherapy and chemotherapy is the standard of care in enhanced and maximal settings for women with stage IB to IVA disease. The addition of concurrent low-dose chemotherapy with radiotherapy is emphasized, but not at the cost of delaying radiation therapy if chemotherapy is not available.

  • In limited-resource settings where brachytherapy is not available, extrafascial hysterectomy or a modification in patients who have residual tumor 2 to 3 months after concurrent chemoradiotherapy and additional boost is recommended.

  • Patients with stage IV or recurrent cervical cancer in basic settings can receive single-agent chemotherapy (carboplatin or cisplatin).

  • For patients who cannot be treated with curative intent, palliative radiotherapy should be used to relieve symptoms of pain and bleeding, if resources are available.

  • In settings of scarce resources, single- or short-course radiotherapy regimens can used for retreatments, if feasible, for persistent or recurrent symptoms.

  • If follow-up care is available, cone biopsy is recommended for women with stage 1A2 disease in basic-resource settings, and cone biopsy plus pelvic lymphadenectomy is recommended in limited settings. For patients in enhanced and maximal settings, radical trachelectomy is recommended for those with stage IB1 cervical cancer with tumor size up to 2 cm who desire fertility-sparing surgery.

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