CSCO Guidelines Conference｜Professor An Jusheng: List of cervical cancer diagnosis and treatment norms, looking forward to the appearance of CSCO cervical cancer guidelines

Foreword The annual academic event "2022 CSCO Guidelines Conference" will be held as scheduled on April 23-24, 2022.
Well-known experts and professors from various oncology fields in China will gather to interpret and discuss the 2022 CSCO Guidelines
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At this meeting, Professor An Jusheng of Cancer Hospital of Chinese Academy of Medical Sciences shared the progress of cervical cancer diagnosis and treatment
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Edited by Yimaitong as follows
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Expert Profile Professor An Jusheng Deputy Chief Physician of Cancer Hospital, Chinese Academy of Medical Sciences Member of Chinese Society of Clinical Oncology (CSCO) Gynecological Oncology Expert Committee Member Young Committee Member of the Society, Member of the Beijing Medical Association Radiation Oncology Branch, Fan Jing-Jin-Hebei Gynecological Cancer Multi-Center Professional Collaboration Group Cervical cancer is the most common female reproductive tract malignant tumor in women
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According to the 2020 WHO-IARC report, there were 604,127 new cervical cancer cases (3.
1%) and 341,831 deaths (3.
3%) worldwide, including 109,741 new cases and 59,060 deaths in China
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Standardizing cervical cancer prevention, diagnosis and treatment in China is a key issue in promoting the construction of a healthy China and improving women's health
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The CSCO Cervical Cancer Guidelines will draw on a number of foreign authoritative guidelines, combined with the characteristics of cervical cancer disease in China, the latest clinical research and results, as well as the experience of previous guideline compilation and the clinical experience of fellow experts, and will be maintained every year.
Update once, keep pace with the times
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The first choice for cervical cancer diagnostic imaging examination is pelvic MRI to evaluate local lesions, and it is necessary to evaluate systemic tumors
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In addition, according to the symptoms and the clinical possibility of distant metastasis, other imaging examinations were performed as appropriate
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Pathological diagnosis is the gold standard for the diagnosis of primary cervical cancer
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The CSCO guidelines will classify the pathological diagnosis according to the WHO 2020 fifth edition of the classification of female genital tumors
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As a supplement to the new classification system for adenocarcinoma (2020NCCN), the International Classification of Cervical Adenocarcinoma (IECC) and silva classification are of great significance for judging the prognosis of cervical adenocarcinoma and formulating treatment plans
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The new molecular pathological diagnosis (2022NCCN) recommends the detection of PD-L1, MMR/MSI, and TMB in recurrent, advanced or metastatic cervical cancer, which is helpful to know the individualized treatment of recurrent and metastatic cervical cancer
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Cervical cancer staging adopts the latest 2018 FIGO cervical cancer staging system.
Based on clinical staging, the staging system uses imaging and pathological methods to supplement the staging information of lymph node metastasis, which can more effectively guide the treatment and prognosis of cervical cancer.
assessment
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The main treatment strategies for newly diagnosed cervical cancer are surgery and radiotherapy, supplemented by chemotherapy, targeted therapy, and immunotherapy; surgery is the main option for early-onset cervical cancer (stage IA-II A); radiotherapy is suitable for all stages of cervical cancer.
Concurrent chemoradiotherapy is the standard treatment for locally advanced cervical cancer (IB3, IIA2, IIB-IVA); individualized treatment plans are formulated according to factors such as stage, pathology, general condition of the patient, and age
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It should be noted in the treatment strategy of stage IA-IIA cervical cancer that for stage IA2 or IB1 (diameter ≤2cm) after strict screening, transvaginal radical trachelectomy + PLND (consider SLN imaging) can be selected, which is the same as type B radical trachelectomy.
Same as hysterectomy; carefully screened stage IB1-IB2 (2-4 cm in diameter), open radical trachelectomy, similar to type C radical hysterectomy; small cell neuroendocrine tumor, gastric adenocarcinoma, malignant Fertility-sparing surgery is not recommended for adenomas (minimally biased adenocarcinomas)
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Based on prospective randomized controlled studies, minimally invasive surgery is associated with lower DFS and OS compared with open radical hysterectomy; the standard procedure for radical hysterectomy is the open approach (category 1); for neoadjuvant chemotherapy For patients with combined surgery, the FIGO and ESMO guidelines point out that neoadjuvant chemotherapy is used in clinical research or areas lacking radiotherapy equipment, and if it is ineffective, it should be transferred to concurrent chemoradiotherapy; neoadjuvant chemotherapy may change the pathological results and affect the assessment of adjuvant radiotherapy/concurrent radiotherapy.
Indications for chemotherapy; the use of neoadjuvant chemotherapy lacks high-level evidence-based evidence
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The standard of postoperative adjuvant treatment for early cervical cancer should be noted that for patients with high risk factors, platinum-based concurrent chemotherapy (category 1) should be selected, and cisplatin is the first choice, and carboplatin is used for those who cannot tolerate it; Patients with intermediate-risk factors should not only be limited to Sedlis factors, but should also consider factors such as adenocarcinoma components and insufficient resection margins, and should also undergo postoperative adjuvant therapy; RTOG0418 and PACER studies have shown that postoperative adjuvant radiotherapy is based on CT three-dimensional images.
The standard treatment plan and conformal block (conformal intensity-modulated technique) are the standard for external pelvic radiotherapy to reduce the side effects of radiotherapy in the bowel and urogenital tract
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It is important to note that the treatment strategy for stage IIB-IVA cervical cancer is that clinical studies of para-aortic lymph node involvement are ongoing to compare surgical staging with imaging staging
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Radical radiotherapy for cervical cancer includes external irradiation and brachytherapy; platinum-based concurrent chemoradiotherapy (category 1), cisplatin is the first choice, and carboplatin is used for those who cannot tolerate it; image-guided three-dimensional afterloading treatment techniques and dose assessment are recommended system (ICRU89, EMBRACE study 2016-2022); the best results were achieved within 8 weeks
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Treatment strategies for stage IVB or recurrence of cervical cancer with distant metastases The treatment strategies for locally/regional recurrence of cervical cancer should pay attention to the patient's previous treatment methods; the relationship with the location of the radiotherapy field; and whether it is a central lesion
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Follow-up needs to be noted that annual cervical/vaginal cytology to detect lower genital tract epithelial lesions is performed as indicated, and patient education, including scientific sexual health education (vaginal dilator use, lubricant/moisturizer, and hormone replacement) Treatment) Editor: Uni Reviewer: Prof.
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