Introduction/Background*From our previously conducted global systematic literature review (SLR) assessing recommended treatment for locally advanced cervical cancer (LACC) it was observed that there was international consensus on the use of concurrent chemoradiotherapy (cCRT) as standard of care (SoC) for Stage IIB-IVA LACC, but recommendations for Stage IB2-IIA LACC varied. Here, we present a subanalysis of European guidelines to determine if recommended LACC treatment is consistent across Europe.

Methodology English-language cervical cancer treatment guidelines and consensus statements were identified through literature databases (1999-2020), international and national health organizations, and general internet searches. Included guidelines represented the latest updates from Europe. Non-English guidelines from EU-5 countries were translated for comparison (Italian [AIOM], German [S3], and French [HAS]) to the 4 European guidelines obtained through this SLR protocol (ESTRO/ESGO/ESP, ESMO, Spain [SEOM], UK [NHS]). An English-language guideline from Germany was excluded because a newer German-language only version was available.

Result(s)*The 7 guidelines were updated between 2010 and 2021 (table 1). ESTRO/ESGO/ESP guidelines used AJCC 8th edition TNM criteria for staging. All others, except SEOM, used FIGO 2009 criteria; SEOM used FIGO 2018 criteria. Table 1 shows recommended treatment by LACC stage. For Stage IB2-IIA2 disease, cCRT was the SoC or an alternative to radical hysterectomy. AIOM was the only guideline to recommend radiotherapy alone for Stage IIA1 disease. cCRT followed by brachytherapy was SoC for suitable patients with Stage IIB-IVA LACC among all European guidelines. For cCRT, a platinum-based regimen was recommended by all, and most guidelines recommended an external beam radiation therapy (EBRT) dose of 45-50 Gy (table 2).

Conclusion*In line with global SLR findings, consensus on the use of cCRT as primary treatment for Stage IIB-IVA LACC was recommended by European guidelines. The ideal cCRT regimen was weekly cisplatin at 40 mg/m2 concurrent with EBRT at 45-50 Gy and followed by brachytherapy. For Stage IB-IIA LACC, recommendations mainly varied between radical hysterectomy and cCRT as options or cCRT alone. Alignment of guidelines with FIGO 2018 staging criteria may help reduce variation in recommended treatment for early-stage LACC.

Funding AstraZeneca

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