The Polish Society of Gynecological Oncology Guidelines for the Diagnosis and Treatment of Cervical Cancer (v2024.0).
Jacek Jan SznurkowskiLubomir BodnarŁukasz SzylbergAgnieszka Zołciak-SiwinskaAnna Dańska-BidzińskaDagmara Klasa-MazurkiewiczAgnieszka RychlikArtur KowalikJoanna StrebMariusz BidzinskiWłodzimierz SawickiPublished in: Journal of clinical medicine (2024)
Background : Recent publications underscore the need for updated recommendations addressing less radical surgery for <2 cm tumors, induction chemotherapy, or immunotherapy for locally advanced stages of cervical cancer, as well as for the systemic therapy for recurrent or metastatic cervical cancer. Aim : To summarize the current evidence for the diagnosis, treatment, and follow-up of cervical cancer and provide evidence-based clinical practice recommendations. Methods : Developed according to AGREE II standards, the guidelines classify scientific evidence based on the Agency for Health Technology Assessment and Tariff System criteria. Recommendations are graded by evidence strength and consensus level from the development group. Key Results : (1) Early-Stage Cancer: Stromal invasion and lymphovascular space involvement (LVSI) from pretreatment biopsy identify candidates for surgery, particularly for simple hysterectomy. (2) Surgical Approach: Minimally invasive surgery is not recommended, except for T1A, LVSI-negative tumors, due to a reduction in life expectancy. (3) Locally Advanced Cancer: concurrent chemoradiation (CCRT) followed by brachytherapy (BRT) is the cornerstone treatment. Low-risk patients (fewer than two metastatic nodes or FIGO IB2-II) may consider induction chemotherapy (ICT) followed by CCRT and BRT after 7 days. High-risk patients (two or more metastatic nodes or FIGO IIIA, IIIB, and IVA) benefit from pembrolizumab with CCRT and maintenance therapy. (4) Metastatic, Persistent, and Recurrent Cancer: A PD-L1 status from pretreatment biopsy identifies candidates for Pembrolizumab with available systemic treatment, while triplet therapy (Atezolizumab/Bevacizumab/chemotherapy) becomes a PD-L1-independent option. Conclusions : These evidence-based guidelines aim to improve clinical outcomes through precise treatment strategies based on individual risk factors, predictors, and disease stages.
Keyphrases
- clinical practice
- locally advanced
- squamous cell carcinoma
- small cell lung cancer
- early stage
- end stage renal disease
- ejection fraction
- risk factors
- minimally invasive
- newly diagnosed
- chronic kidney disease
- healthcare
- rectal cancer
- coronary artery bypass
- public health
- prognostic factors
- stem cells
- bone marrow
- mesenchymal stem cells
- sentinel lymph node
- combination therapy
- risk assessment
- low dose
- squamous cell
- climate change
- acute coronary syndrome
- patient reported
- young adults
- cell therapy
- lymph node metastasis
- atrial fibrillation