Diagnosis, Therapy and Follow-up of Cervical Cancer. Guideline of the DGGG, DKG and DKH (S3-Level, AWMF Registry No. 032/033OL, May 2021) – Part 2 with Recommendations on Psycho-oncology, Rehabilitation, Follow-up, Recurrence, Palliative Therapy and Healthcare Facilities

Abstract

Aim This is an update of the interdisciplinary S3-guideline on the Diagnosis, Therapy and Follow-up of Cervical Cancer (AWMF Registry No. 032/033OL), published in March 2021. The work on the updated guideline was funded by German Cancer Aid (Deutsche Krebshilfe) as part of the German Guideline Program in Oncology. The guideline was coordinated by the German Society of Gynecology and Obstetrics (Deutsche Gesellschaft für Gynäkologie und Geburtshilfe, DGGG) and the Working Group on Gynecological Oncology (Arbeitsgemeinschaft Gynäkologische Onkologie, AGO) of the German Cancer Society (Deutsche Krebsgesellschaft, DKG).

Method The process used to update the 2014 S3-guideline was based on an appraisal of the available evidence using the criteria of evidence-based medicine, adaptations of existing evidence-based national and international guidelines or – if evidence was lacking – on the consensus of the specialists involved in compiling the update. After an initial review of the current literature was carried out according to a prescribed algorithm, several areas were identified which, in contrast to the predecessor version from September 2014, required new recommendations or statements which would take account of more recently published literature and the recent appraisal of new evidence.

Recommendations The short version of this guideline consists of recommendations and statements on palliative therapy and follow-up of patients with cervical cancer. The most important aspects included in this updated guideline are the new FIGO classification published in 2018, the radical open surgery approach used to treat cervical cancer up to FIGO stage IB1, and the use of the sentinel lymph node technique for tumors ≤ 2 cm. Other changes include the use of PET-CT, new options in radiotherapy (e.g., intensity-modulated radiotherapy, image-guided adaptive brachytherapy), and drug therapies to treat recurrence or metastasis.

Key words

guideline - cervical cancer - cervical intraepithelial neoplasia - therapy - follow-up

Publikationsverlauf

Eingereicht: 29. September 2021
Eingereicht: 14. Oktober 2021

Angenommen: 17. Oktober 2021

Artikel online veröffentlicht:
11. Februar 2022

• References/Literatur

• 1 Leitlinienprogramm Onkologie (Deutsche Krebsgesellschaft, Deutsche Krebshilfe, AWMF). Supportive Therapie bei onkologischen PatientInnen – Langversion 1.3, 2020, AWMF Registernummer: 032/054OL. Online (Stand: 01.09.2021): https://www.leitlinienprogramm-onkologie.de/leitlinien/supportive-therapie/
• 2 Choi H, Palmer MH, Park J. Meta-analysis of pelvic floor muscle training: randomized controlled trials in incontinent women. Nurs Res 2007; 56: 226-234
• 3 Dumoulin C, Hay-Smith J. Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database Syst Rev 2010; (01) CD005654
• 4 Hosker G, Cody JD, Norton CC. Electrical stimulation for faecal incontinence in adults. Cochrane Database Syst Rev 2007; (03) CD001310
• 5 Imamura M, Abrams P, Bain C. et al. Systematic review and economic modelling of the effectiveness and cost-effectiveness of non-surgical treatments for women with stress urinary incontinence. Health Technol Assess 2010; 14: 1-188 iii–iv
• 6 Norton C, Cody JD. Biofeedback and/or sphincter exercises for the treatment of faecal incontinence in adults. Cochrane Database Syst Rev 2012; (07) CD002111
• 7 Shamliyan TA, Kane RL, Wyman J. et al. Systematic review: randomized, controlled trials of nonsurgical treatments for urinary incontinence in women. Ann Intern Med 2008; 148: 459-473
• 8 Theofrastous JP, Wyman JF, Bump RC. et al. Effects of pelvic floor muscle training on strength and predictors of response in the treatment of urinary incontinence. Neurourol Urodyn 2002; 21: 486-490
• 9 Velthuis MJ, Agasi-Idenburg SC, Aufdemkampe G. et al. The effect of physical exercise on cancer-related fatigue during cancer treatment: a meta-analysis of randomised controlled trials. Clin Oncol 2010; 22: 208-221
• 10 Cramp F, Daniel J. Exercise for the management of cancer-related fatigue in adults. Cochrane Database Syst Rev 2008; (02) CD006145
• 11 Brown JC, Huedo-Medina TB, Pescatello LS. et al. Efficacy of exercise interventions in modulating cancer-related fatigue among adult cancer survivors: a meta-analysis. Cancer Epidemiol Biomarkers Prev 2011; 20: 123-133
• 12 Khatcheressian JL, Wolff AC, Smith TJ. et al. American Society of Clinical Oncology 2006 update of the breast cancer follow-up and management guidelines in the adjuvant setting. J Clin Oncol 2006; 24: 5091-5097
• 13 Grunfeld E, Dhesy-Thind S, Levine M. Clinical practice guidelines for the care and treatment of breast cancer: follow-up after treatment for breast cancer (summary of the 2005 update). CMAJ 2005; 172: 1319-1320
• 14 Pestalozzi BC, Luporsi-Gely E, Jost LM. et al. ESMO Minimum Clinical Recommendations for diagnosis, adjuvant treatment and follow-up of primary breast cancer. Ann Oncol 2005; 16 (Suppl. 01) i7-i9
• 15 Hurria A, Hudis C. Follow-up care of breast cancer survivors. Crit Rev Oncol Hematol 2003; 48: 89-99
• 16 Rojas MP, Telaro E, Russo A. et al. Follow-up strategies for women treated for early breast cancer. Cochrane Database Syst Rev 2005; (01) CD001768
• 17 Palli D, Russo A, Saieva C. et al. Intensive vs. clinical follow-up after treatment of primary breast cancer: 10-year update of a randomized trial. National Research Council Project on Breast Cancer Follow-up. JAMA 1999; 281: 1586
• 18 Gulliford T, Opomu M, Wilson E. et al. Popularity of less frequent follow up for breast cancer in randomised study: initial findings from the hotline study. BMJ 1997; 314: 174-177
• 19 van Nagell jr. JR, Rayburn W, Donaldson ES. et al. Therapeutic implications of patterns of recurrence in cancer of the uterine cervix. Cancer 1979; 44: 2354-2361
• 20 Guskova E, Kit OI, Nerodo GA. et al. Prognostic factors of cervical cancer recurrence. J Clin Oncol 2016; 34(15_suppl): e17025
• 21 Hong JH, Tsai CS, Lai CH. et al. Recurrent squamous cell carcinoma of cervix after definitive radiotherapy. Int J Radiat Oncol Biol Phys 2004; 60: 249-257
• 22 Kamura T, Tsukamoto N, Tsuruchi N. et al. Multivariate analysis of the histopathologic prognostic factors of cervical cancer in patients undergoing radical hysterectomy. Cancer 1992; 69: 181-186
• 23 Noh JM, Park W, Kim YS. et al. Comparison of clinical outcomes of adenocarcinoma and adenosquamous carcinoma in uterine cervical cancer patients receiving surgical resection followed by radiotherapy: a multicenter retrospective study (KROG 13-10). Gynecol Oncol 2014; 132: 618-623
• 24 Perez CA, Fox S, Lockett MA. et al. Impact of dose in outcome of irradiation alone in carcinoma of the uterine cervix: analysis of two different methods. Int J Radiat Oncol Biol Phys 1991; 21: 885-898
• 25 Scatchard K, Forrest JL, Flubacher M. et al. Chemotherapy for metastatic and recurrent cervical cancer. Cochrane Database Syst Rev 2012; (10) CD006469
• 26 Hirte HW, Strychowsky JE, Oliver T. et al. Chemotherapy for recurrent, metastatic, or persistent cervical cancer: a systematic review. Int J Gynecol Cancer 2007; 17: 1194-1204
• 27 Tzioras S, Pavlidis N, Paraskevaidis E. et al. Effects of different chemotherapy regimens on survival for advanced cervical cancer: systematic review and meta-analysis. Cancer Treat Rev 2007; 33: 24-38
• 28 Kitagawa R, Katsumata N, Shibata T. et al. Paclitaxel Plus Carboplatin Versus Paclitaxel Plus Cisplatin in Metastatic or Recurrent Cervical Cancer: The Open-Label Randomized Phase III Trial JCOG0505. J Clin Oncol 2015; 33: 2129-2135
• 29 Lorusso D, Petrelli F, Coinu A. et al. A systematic review comparing cisplatin and carboplatin plus paclitaxel-based chemotherapy for recurrent or metastatic cervical cancer. Gynecol Oncol 2014; 133: 117-123
• 30 Long 3rd HJ, Bundy BN, Grendys jr. EC. et al. Randomized phase III trial of cisplatin with or without topotecan in carcinoma of the uterine cervix: a Gynecologic Oncology Group Study. J Clin Oncol 2005; 23: 4626-4633
• 31 Tewari KS, Sill MW, Penson RT. et al. Bevacizumab for advanced cervical cancer: final overall survival and adverse event analysis of a randomised, controlled, open-label, phase 3 trial (Gynecologic Oncology Group 240). Lancet 2017; 390: 1654-1663
• 32 Leitlinienprogramm Onkologie (Deutsche Krebsgesellschaft, Deutsche Krebshilfe, AWMF). Palliativmedizin für Patienten mit einer nicht-heilbaren Krebserkrankung, Langversion 2.1, 2020, AWMF-Registernummer: 128/001OL. Online (Stand: 01.04.2020): https://www.leitlinienprogramm-onkologie.de/leitlinien/palliativmedizin/
• 33 Haun MW, Estel S, Rucker G. et al. Early palliative care for adults with advanced cancer. Cochrane Database Syst Rev 2017; (06) CD011129
• 34 Adler K, Schlieper D, Kindgen-Milles D. et al. Integration of palliative care into intensive care: Systematic review. Anaesthesist 2017; 66: 660-666
• 35 Dalgaard KM, Bergenholtz H, Nielsen ME. et al. Early integration of palliative care in hospitals: A systematic review on methods, barriers, and outcome. Palliat Support Care 2014; 12: 495-513
• 36 Davis MP, Temel JS, Balboni T. et al. A review of the trials which examine early integration of outpatient and home palliative care for patients with serious illnesses. Ann Palliat Med 2015; 4: 99-121
• 37 Gaertner J, Siemens W, Meerpohl JJ. et al. Effect of specialist palliative care services on quality of life in adults with advanced incurable illness in hospital, hospice, or community settings: systematic review and meta-analysis. BMJ 2017; 357: j2925
• 38 Hui D, Kim YJ, Park JC. et al. Integration of oncology and palliative care: a systematic review. Oncologist 2015; 20: 77-83
• 39 Tassinari D, Drudi F, Monterubbianesi MC. et al. Early Palliative Care in Advanced Oncologic and Non-Oncologic Chronic Diseases: A Systematic Review of Literature. Rev Recent Clin Trials 2016; 11: 63-71
• 40 Hui D, Meng YC, Bruera S. et al. Referral Criteria for Outpatient Palliative Cancer Care: A Systematic Review. Oncologist 2016; 21: 895-901
• 41 Fertility preservation for patients with malignant disease. Guideline of the DGGG, DGU and DGRM (S2k-Level, AWMF Registry No. 015/082, November 2017). Online (Stand: 31.03.2020): http://www.awmf.org/leitlinien/detail/ll/015-082.html
• 42 De Vincenzo R, Tortorella L, Ricci C. et al. Locally advanced cervical cancer complicating pregnancy: A case of competing risks from the Catholic University of the Sacred Heart in Rome. Gynecol Oncol 2018; 150: 398-405
• 43 Fader AN, Alward EK, Niederhauser A. et al. Cervical dysplasia in pregnancy: a multi-institutional evaluation. Am J Obstet Gynecol 2010; 203: 113.e1-113.e6
• 44 Cohen JG, Kapp DS, Shin JY. et al. Small cell carcinoma of the cervix: treatment and survival outcomes of 188 patients. Am J Obstet Gynecol 2010; 203: 347.e1-347.e6
• 45 Lee SW, Nam JH, Kim DY. et al. Unfavorable prognosis of small cell neuroendocrine carcinoma of the uterine cervix: a retrospective matched case-control study. Int J Gynecol Cancer 2010; 20: 411-416
• 46 Tian WJ, Zhang MQ, Shui RH. Prognostic factors and treatment comparison in early-stage small cell carcinoma of the uterine cervix. Oncol Lett 2012; 3: 125-130
• 47 Moore DH, Blessing JA, McQuellon RP. et al. Phase III study of cisplatin with or without paclitaxel in stage IVB, recurrent, or persistent squamous cell carcinoma of the cervix: a gynecologic oncology group study. J Clin Oncol 2004; 22: 3113-3119
• 48 McCusker ME, Cote TR, Clegg LX. et al. Endocrine tumors of the uterine cervix: incidence, demographics, and survival with comparison to squamous cell carcinoma. Gynecol Oncol 2003; 88: 333-339
• 49 Chen J, Macdonald OK, Gaffney DK. Incidence, mortality, and prognostic factors of small cell carcinoma of the cervix. Obstet Gynecol 2008; 111: 1394-1402
• 50 Tempfer CB, Tischoff I, Dogan A. et al. Neuroendocrine carcinoma of the cervix: a systematic review of the literature. BMC Cancer 2018; 18: 530
• 51 Xu F, Ma J, Yi H. et al. Clinicopathological Aspects of Small Cell Neuroendocrine Carcinoma of the Uterine Cervix: a Multicenter Retrospective Study and Meta-Analysis. Cell Physiol Biochem 2018; 50: 1113-1122