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EPV069/#40 Systematic comparison of international treatment guidelines for locally advanced cervical cancer
  1. E Pujade-Lauraine1,
  2. A Leary2,
  3. J Takyar3,
  4. A Nunes4,
  5. JD Hernandez Chagui4,
  6. K Rabon-Stith4 and
  7. B Monk5
  1. 1Arcagy-Gineco, Medical Oncology, Paris, France
  2. 2Gustave Roussy Cancer Center, INSERM U981, and Groupe d’Investigateurs Nationaux pour l’Etude des Cancers Ovariens (GINECO), Gynecological Unit, Villejuif, France
  3. 3Parexel International, Evidence and Heor, Chandigarh, India
  4. 4AstraZeneca, Global Medical Affairs, Gaithersburg, USA
  5. 5Arizona Oncology (US Oncology Network), Gynecologic Oncology, Obstetrics and Gynecology, Phoenix, USA


Objectives Globally, cervical cancer is a leading cause of death. Lack of international consensus on standard-of-care (SoC) treatment for locally advanced cervical cancer (LACC) (Stages IB2-IVA) may contribute to inconsistent treatment. We compared LACC treatment recommendations from international guidelines.

Methods Literature databases (1999–2020), national authority websites, and bibliographies were searched for English-language cervical cancer guidelines, with no restriction on geography. Included guidelines were treatment-focused and represented the latest update.

Results Thirty-four guidelines were identified (figure 1), with the majority updated 2016–2021. Seven provided only high-level overviews of treatment modalities, and were excluded. Treatment recommendations were based on FIGO 2009 (n=20 guidelines), FIGO 2018 (n=6), and TNM (n=1) staging. For Stage IB2-IIA2, treatment options were diverse within/between guidelines and included radical hysterectomy (RH), cCRT, radiotherapy. The most common recommendation was a choice of RH/cCRT (IB2 n=12; IIA n=18), with variable treatment selection criteria between guidelines. Adjuvant cCRT/radiotherapy after RH was advisable with high/intermediate recurrence risk (n=23). For Stage IIB-IVA, cCRT was SoC, with ≥67% guideline consensus. However, for Stage IIB, surgery was SoC in Japan/Germany. Ten guidelines offered Stage IVA treatment alternatives. Kenya/Gambia recommendations were distinct, offering chemotherapy alone and/or excluding cCRT. Consensus cCRT regimen was weekly cisplatin (40mg/m2) concurrent with external beam radiotherapy followed by brachytherapy; for 6 guidelines it was unclear if cCRT included brachytherapy.

Conclusions With few exceptions, there is international consensus for cCRT as SoC for Stage IIB-IVA LACC, whereas recommendations for Stage IB2-IIA disease varied. Funding: AstraZeneca

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