ESMO updates cervical cancer guidelines with key change for early stage therapy

  • ESMO
  • 1 Apr 2020

  • curated by Deepa Koli
  • Univadis Clinical Summaries
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Takeaway

  • The European Society for Medical Oncology (ESMO) updated its 2017 Clinical Practice guidelines for treatment of cervical cancer and amended primary treatment in the management of local/locoregional disease.

Key recommendation

  • In International Federation of Gynecology and Obstetrics (FIGO) stage IA2, IB, and IIA cervical cancer, radical hysterectomy performed by laparoscopy or robot-assisted surgery cannot be regarded as the preferred treatment vs open surgery.
  • Patient counseling about the risks and benefits of the procedures is advised.
  • The update was based on a randomized phase 3 trial and epidemiological study.
  • The randomized phase 3 LACC trial evaluated 631 patients with stage IA1, IA2, or IB1 cervical cancer and a histological subtype of squamous cell carcinoma, adenocarcinoma, or adenosquamous carcinoma.
    • Patients were randomly assigned to undergo minimally invasive surgery (MIS; laparoscopy or robot-assisted) or conventional open surgery.
    • MIS was associated with lower rates of:
      • Disease-free survival: 3-year rate, 91.2% vs 97.1%.
        • HR, 3.74 (95% CI, 1.63-8.58). 
      • OS: 3-year rate, 93.8% vs 99.0%.
        • HR, 6.00 (95% CI, 1.77-20.30).
  • An epidemiological study of 2461 women with stage IA2/IB1 disease showed significantly worse 4-year OS with MIS vs open surgery (HR, 1.65; P=.002).