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. 2024 Jul 25;13(15):4351.
doi: 10.3390/jcm13154351.

The Polish Society of Gynecological Oncology Guidelines for the Diagnosis and Treatment of Cervical Cancer (v2024.0)

Jacek J Sznurkowski  1 , Lubomir Bodnar  2   3 , Łukasz Szylberg  4   5 , Agnieszka Zołciak-Siwinska  6 , Anna Dańska-Bidzińska  7 , Dagmara Klasa-Mazurkiewicz  8 , Agnieszka Rychlik  6 , Artur Kowalik  9   10 , Joanna Streb  11 , Mariusz Bidziński  6 , Włodzimierz Sawicki  12
Affiliations

The Polish Society of Gynecological Oncology Guidelines for the Diagnosis and Treatment of Cervical Cancer (v2024.0)

Jacek J Sznurkowski et al. J Clin Med. .

Abstract

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.

Keywords: adjuvant; cervical cancer; diagnosis; early stage; follow up; imaging; immunotherapy; locally advanced; metastatic; persistent; radiotherapy; recommendation; recurrent; surgery.

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Conflict of interest statement

J.J.S.: advisory board for GSK, paid lectures from AstraZeneca, GSK; L.B.: advisory board for GSK, AstraZeneca, pharma, MSD; personal fees from AstraZeneca, Roche, GSK and research funding and support from AstraZeneca, Roche, Novartis, MSD, Lilly, OncoQuest, Regeneron Pharmaceutical, Gilead, Amgen, Exelixis. Inc.; L.S.: advisory board for Sakura, paid lectures from AstraZeneca, Roche, MSD, Ferring and GSK; A.K.: advisory board for GSK, AstraZeneca, Pfizer paid lectures from AstraZeneca, Pfizer, Roche and GSK; research funding from AstraZeneca; D.M.: advisory board for GSK, AstraZeneca, paid lectures from AstraZeneca and GSK; M.B.: advisory board for GSK, Astra Zeneca, J&J and Roche; A.Z.S.: none; J.S.: advisory board for GSK, AstraZeneca, MSD; personal fees covered by AstraZeneca, Roche, Pfizer, Novartis, MSD, Lilly; A.D.B.: advisory board for GSK, AstraZeneca, MSD, pharma, personal fees for lectures from AstraZeneca, Lilly, GSK, MSD, research funding and support from AstraZeneca, MSD, GSK; A.R.: advisory board for Medtronic, speaker for Medtronic, Johnson and Johnson, AstraZeneca and GSK; W.S.: none.

Figures

Figure 1
Figure 1
Illustration of the management of HSIL.
Figure 2
Figure 2
Illustration of the decision tree for treatment of cr FIGO stage IB1.
Figure 3
Figure 3
Selection criteria for surgical treatment of cr FIGO stage IB2 and IIA1. * Peters criteria, ** Sedlis criteria.
Figure 4
Figure 4
Illustration of the decision tree for managing cr FIGO stage IB2–IA1 (excluded from surgery) and FIGO IB3/IIA2–IVA.
Figure 5
Figure 5
Illustration of the decision tree for systemic treatment of metastatic or persistent/recurrent cervical cancer (mprCC). Detailed data on systemic treatment are described in Supplementary File S6. * If available.
Figure 6
Figure 6
Illustration of the proposed treatment approach for oligometastatic disease.
Figure 7
Figure 7
Illustration of the recommended management for fertility-sparing treatment.
See this image and copyright information in PMC

References

    1. Brouwers M.C., Kho M.E., Browman G.P., Burgers J.S., Cluzeau F., Feder G., Fervers B., Graham I.D., Grimshaw J., Hanna S.E., et al. AGREE II: Advancing Guideline Development, Reporting and Evaluation in Health Care. CMAJ Can. Med. Assoc. J. 2010;182:E839–E842. doi: 10.1503/cmaj.090449. - DOI - PMC - PubMed
    1. AGREE II. [(accessed on 21 April 2024)]; Available online: https://www.aotm.gov.pl/zalecenia-kliniczne/narzedzia/agree-ii/
    1. WHO Classification of Tumours Editorial Board . Female Genital Tumours WHO Classification of Tumours. 5th ed. Volume 4. WHO Classification of Tumours Editorial Board; Geneva, Switzerland: 2020.
    1. Peirson L., Fitzpatrick-Lewis D., Ciliska D., Warren R. Screening for Cervical Cancer: A Systematic Review and Meta-Analysis. Syst. Rev. 2013;2:35. doi: 10.1186/2046-4053-2-35. - DOI - PMC - PubMed
    1. Jansen E.E.L., Zielonke N., Gini A., Anttila A., Segnan N., Vokó Z., Ivanuš U., McKee M., de Koning H.J., de Kok I.M.C.M., et al. Effect of Organised Cervical Cancer Screening on Cervical Cancer Mortality in Europe: A Systematic Review. Eur. J. Cancer. 2020;127:207–223. doi: 10.1016/j.ejca.2019.12.013. - DOI - PubMed

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