ESGO/ESTRO/ESP Guidelines for the management of patients with cervical cancer – Update 2023*

Abstract

In 2018, the European Society of Gynecological Oncology (ESGO) jointly with the European Society for Radiotherapy and Oncology (ESTRO) and the European Society of Pathology (ESP) published evidence-based guidelines for the management of patients with cervical cancer. Given the large body of new evidence addressing the management of cervical cancer, the three sister societies jointly decided to update these evidence-based guidelines. The update includes new topics to provide comprehensive guidelines on all relevant issues of diagnosis and treatment in cervical cancer.To serve on the expert panel (27 experts across Europe) ESGO/ESTRO/ESP nominated practicing clinicians who are involved in managing patients with cervical cancer and have demonstrated leadership through their expertise in clinical care and research, national and international engagement, profile, and dedication to the topics addressed. To ensure the statements were evidence based, new data identified from a systematic search was reviewed and critically appraised. In the absence of any clear scientific evidence, judgment was based on the professional experience and consensus of the international development group. Before publication, the guidelines were reviewed by 155 independent international practitioners in cancer care delivery and patient representatives.These updated guidelines are comprehensive and cover staging, management, follow-up, long-term survivorship, quality of life and palliative care. Management includes fertility sparing treatment, early and locally advanced cervical cancer, invasive cervical cancer diagnosed on a simple hysterectomy specimen, cervical cancer in pregnancy, rare tumors, recurrent and metastatic diseases. The management algorithms and the principles of radiotherapy and pathological evaluation are also defined.

Recent advances in treating female genital human papillomavirus related neoplasms with topical imiquimod

“…Despite effective cervical screening programs and extensive HPV vaccination, cervical cancer remains a public health issue of cancer morbidity and mortality in high‐income countries. Surgical treatment remains the cornerstone of early‐stage cancers, while in more advanced stages radiotherapy and chemotherapy have a pivotal role, 92 however, treatment of cervical cancer can significantly affect women's quality of life 93…”

“…The efficacy of Imiquimod in cervical cancer treatment has been demonstrated in many cancer cell lines such as squamous cell carcinoma (SCC12) 92 . Besides local immunity activation, imiquimod can also act directly on cancer cells.…”

Ovarian preservation in gynecologic oncology: current indications and techniques

“…Ovarian conservation in cervical cancer is strictly related to the technique of ovarian transposition due to the risk of adjuvant (chemo)radiotherapy after radical surgery (estimated between 17 and 49% of cases [29,30]) or to the treatment of locally advanced stage with exclusive chemo-radiotherapy [31]. In this context, it is known that a radiotherapy dose of 10 Gy can be sufficient to cause a premature ovarian failure [32].…”

“…Overall, the risk of ovarian recurrence and metastasis in conserved ovary is strictly related to the stage of disease at diagnosis and the presence of unfavorable risk factors. In early-stage disease (tumors <4 cm confined to the cervix, with no evidence of lymph node metastasis), ovarian conservation should be considered in all patients with squamous cell carcinoma and HPV-associated adenocarcinoma in premenopausal age, as promoted by international guidelines [31]. In patients at risk of postoperative adjuvant radiotherapy, ovarian transposition should be considered [41].…”

ESGO/ESTRO/ESP updated guidelines in cervical cancer

“…New and exciting data continue to emerge in the management of patients with cervical cancer. To that end, the European Society of Gynaecological Oncology/European Society for Radiotherapy and Oncology/European Society of Pathology (ESGO/ESTRO/ESP) groups have come together to deliver a comprehensive new set of guidelines in order to give clinicians a valuable resource aimed at providing the most sound and evidenced-based recommendations to patients diagnosed with cervical cancer 1. The members of the societies who worked to develop such guidelines ought to be commended for their effort and time devoted to an extensive review of the literature and detailed process to achieve consensus and target all facets of the management of patients with cervical cancer.…”