Management of recurrent cervical cancer

Clinical practice guidelines for gynecologic cancers have been developed by academic society from several countries. Each guideline reflected their own insurance system and unique medical environment, based on the published evidence. The Korean Society of Gynecologic Oncology (KSGO) published the first edition of practice guidelines for gynecologic cancer treatment in late 2006; the second edition was released in July 2010 as an evidence-based recommendation. The Guidelines Revision Committee was established in 2015 and decided to develop the third edition of the guidelines in an advanced format based on evidence-based medicine, embracing up-to-date clinical trials and qualified Korean data. These guidelines cover strategies for diagnosis and treatment of primary and recurrent cervical cancer. The committee members and many gynecologic oncologists derived key questions through discussions, and a number of relevant scientific literature were reviewed in advance. Recommendations for each specific question were developed by the consensus conference, and they are summarized here, along with the details. The objective of these practice guidelines is to establish standard policies on issues in clinical practice related to the management in cervical cancer based on the results in published papers to date and the consensus of experts as a KSGO Consensus Statement.

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“…Chemotherapy, surgical resection, radiation therapy or CCRT could be considered in the case of isolated recurrence [6162]. …”

Section: Clinical Considerations and Recommendationsmentioning

confidence: 99%

Practice guidelines for management of cervical cancer in Korea: a Korean Society of Gynecologic Oncology Consensus Statement

et al. 2017

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“…The majority (80%-90%) of patients with recurrent disease will experience symptoms and exhibit signs that will lead to investigations being performed to confirm diagnosis. 27 Special investigation can be performed to rule out or confirm recurrence. Examination under anesthesia with biopsy from suspicious areas, with parametrial biopsy or aspirates, is commonly required in the assessment of painful lesions.…”

Section: Imaging Techniquesmentioning

confidence: 99%

Surveillance Procedures for Patients With Cervical Carcinoma: A Review of the Literature

Zanagnolo

Minig

Gadducci

et al. 2009

International Journal of Gynecological Cancer

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Cervical cancer is still one of the most common malignancies in women. Treatment of cervical cancer is very successful, especially in the early stage. However, some patients will experience recurrence. The primary purpose of follow-up programs is early detection of recurrence disease that should be more likely to be amenable to treatment, thereby improving the clinical outcome. Although, in the literature, most studies have shown that the surveillance programs did not improve the clinical outcome of patients with diagnosis of recurrence, this clinical practice is regarded as traditional management. The use of Papanicolaou tests to detect recurrent cervical cancer is not sufficiently justified. The assessment of tumor markers such as the squamous cell carcinoma antigen could be useful. Imaging techniques are important for the detection and assessment of recurrent disease. The role of chest x-rays in detecting asymptomatic recurrence in patients treated for cervical carcinoma remains controversial. Detection of a new abnormal mass or the changes in the size of a known lesion caused by cancer growth and the determination of the extent of recurrence with computed tomography and magnetic resonance imaging may provide clinical assistance in the selection of optimal therapy. The fluoro-2-deoxy-glucose-positron emission tomography for surveillance only show 80% of specificity and accuracy with negative predictive value of 100%. Integrated fluoro-2-deoxy-glucose-positron emission tomography/computed tomography provides precise anatomic localization of suspicious areas and, therefore, a better diagnostic interpretation with a possible impact on disease-free survival as well. In conclusion, our review confirms the need for prospective studies to compare the effectiveness of different follow-up regimens measuring overall survival and quality of life parameters as outcomes.

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“…Patients who develop pelvic recurrence after radical hysterectomy may be salvaged with chemoradiotherapy if they have not previously been irradiated. 25 Central pelvic recurrences after radiation or chemoradiotherapy may undergo curative surgery with pelvic exenteration in the absence of metastatic disease. 25…”

Section: Follow-upmentioning

confidence: 99%