The guidelines address indications and best practices for external-beam radiation therapy (EBRT) and brachytherapy in the postoperative and definitive settings. They also cover intensity-modulated radiation therapy (IMRT) and the use of chemotherapy and surgery when combined with radiation treatments.
Key recommendations for locally advanced cancer included the following:
- Radiation with concurrent platinum-based chemotherapy for patients with high risk factors after radical hysterectomy in the postoperative setting
- Radiation therapy for patients with intermediate risk factors in the postoperative setting
- IMRT when performing EBRT in the postoperative setting
- Chemoradiation treatment for patients with stage IB3-IVA cancers according to International Federation of Gynecology and Obstetrics (FIGO) guidelines in the definitive setting
- Brachytherapy for patients receiving radiation or chemoradiation in the definitive setting
The guidelines also conditionally recommended radiation or chemoradiation in the definitive setting for patients with FIGO stage IA1-IB2 cancers who cannot undergo an operation, brachytherapy for patients with positive margins, and IMRT when performing EBRT in the definitive setting.
The guidelines were created by a multidisciplinary panel following a systematic review of scientific articles published between January 1993 and October 2018. They are endorsed by multiple societies, including the Canadian Association of Radiation Oncology, the European Society for Radiotherapy and Oncology, and the Society of Gynecologic Oncology.
ASTRO also cautioned that the guidelines were completed before the novel coronavirus pandemic and do not address COVID-19 or its role in cervical cancer guidance or treatment. However, guideline task force chair Dr. Akila Viswanathan expressed concern about the consequences of waiting to treat cervical cancer.
"Cervical cancer is one of those cancers where you just can't wait," Viswanathan stated in a press release. "You need to treat it right away in order to have the greatest chance of cure."
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