ESMO updates cervical cancer treatment recommendations

  • European Society for Medical Oncology

  • Oncology guidelines update
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The European Society for Medical Oncology (ESMO) has updated its recommendations for the treatment of cervical cancer.

In the ESMO Clinical Practice Guidelines on cervical cancer, radical hysterectomy with bilateral lymph node dissection with or without sentinel lymph node (SLN), carried out either by laparotomy or laparoscopy, was regarded as standard treatment in patients with FIGO (Fédération Internationale de Gynécologie et d’Obstétrique) stage IA2, IB, and IIA, if the patient does not wish to preserve fertility.

However, in an eUpdate, ESMO said the results of the randomised, phase 3 Laparoscopic Approach to Cervical Cancer (LACC) trial make it necessary to amend the statement.

In the trial, 631 patients with stage IA1 (lymphovascular invasion), IA2 or IB1 cervical cancer, and a histological subtype of squamous cell carcinoma, adenocarcinoma or adeno-squamous carcinoma were randomly assigned to undergo minimally invasive surgery (laparoscopy or robot-assisted surgery) or conventional open surgery.

Minimally invasive surgery was associated with a lower rate of disease-free survival (DFS) than open surgery (3-year rate, 91.2% versus 97.1%; hazard ratio [HR] for disease recurrence or death from cervical cancer 3.74; 95% CI 1.63-8.58), a difference that remained after adjustment for prognostic factors.

Minimally invasive surgery was also associated with a lower rate of overall survival (3-year rate, 93.8% versus 99.0%; HR for death from any cause 6.00; 95% CI 1.77-20.30).

The findings were confirmed in an epidemiological study, indicating that minimally invasive radical hysterectomy is associated with shorter overall survival than open surgery among women with stage IA2 or IB1 cervical carcinoma.

Consequently, ESMO recommends that radical hysterectomy performed by laparoscopy or robot-assisted surgery cannot be regarded as the preferred treatment in comparison with open surgery in patients with FIGO stage IA2, IB, and IIA disease.

It advises that patients should be counselled about the risks and benefits of the different types of surgery.