[Cervical cancer: Guidelines for clinical practice]

Abstract

Objectives: To establish clinical practice guidelines for the management of women with cervical cancer.

Methods: An organizing committee composed of a chair, two coordinators, and a methodologist defined the questions to be addressed and appointed a working group of 36 experts. Questions were formulated using the PICO format (Patients, Intervention, Comparison, Outcome). A literature review was conducted using the GRADE® methodology, leading to the development of 130 questions. All texts and recommendations were based on the 2018 FIGO classification for cervical cancer. The recommendations were externally validated using the Delphi method with input from 87 experts.

Results: The 130 questions resulted in 158 recommendations covering the full spectrum of cervical cancer management: initial assessment (clinical, imaging, conization, nodal staging), treatment (surgery, chemoradiotherapy, brachytherapy, adjuvant therapies), response evaluation, follow-up, fertility preservation, management of recurrences, and three specific situations (incidental finding on hysterectomy specimen, residual cervix, and elderly women). Among the 158 recommendations, 35 were strong (including 5 based on very low-quality evidence), 52 were weak, and for 71, no recommendation could be made due to insufficient data. The quality of evidence was rated as high (n=20), moderate (n=15), low (n=25), or very low (n=27).

Conclusion: These guidelines help harmonize the management of cervical cancer in France and support healthcare professionals with evidence-based decision-making tools.

Keywords: Brachytherapy; Cancer du col; Cervical cancer; Concurrent chemoradiotherapy; Curiethérapie; Follow-up; Radio-chimiothérapie concomitante; Stadification; Staging; Surveillance; Traitement; Treatment.