Comparison of global treatment guidelines for locally advanced cervical cancer to optimize best care practices: A systematic and scoping review.

BACKGROUND

Survival outcomes for cervical cancer differ between countries and world regions. Locally advanced cervical cancer (LACC) is associated with poorer outcomes than early-stage disease. Country-specific variations in diagnostic and treatment recommendations might contribute to differences in LACC outcomes among countries.

OBJECTIVE

We compared international and country-specific guidelines for LACC diagnostic imaging and treatment recommendations.

METHODS

A systematic literature review and targeted search were used to identify cervical cancer treatment guidelines published between January 1999-August 2021. Guidelines were identified via literature databases, health technology assessment databases, disease-specific websites, and health organization websites. The targeted search included guidelines from countries in regions known to have high cervical cancer prevalence or mortality. Non-English guidelines were translated by native speakers or online translation services.

RESULTS

Forty-six guidelines from 31 countries, regions, and international organizations were compared (41/46 using staging criteria, 27 of which used 2009 FIGO). Most guidelines recommended imaging tests for diagnosis and staging. Chest X-ray, intravenous pyelogram, CT, and MRI were commonly recommended for diagnosis and staging while MRI and PET-CT were recommended for the assessment of lymph node status and distant metastases, with a preference for PET-CT over MRI. There was global consensus for cisplatin-based concurrent chemoradiation as primary treatment for stages IIB to IVA, with few exceptions. Treatment recommendations for stages IB2 to IIA2 varied. Most guidelines agreed on adjuvant concurrent chemoradiation after radical hysterectomy when there is a high recurrence risk, and adjuvant radiotherapy when there is an intermediate recurrence risk. Recommendations for other adjuvant and neoadjuvant therapies varied among the guidelines.

CONCLUSIONS

Differences among treatment guidelines by LACC stage might be influenced by staging criteria used, resource availability, and prevention program effectiveness. Addressing these areas may unify guidelines and improve global outcomes. Review and update of guidelines will be important as novel LACC therapies become available.

Informations de copyright

Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.

Déclaration de conflit d'intérêts

Declaration of Competing Interest E. Pujade-Lauraine reports personal fees and non-financial support from AstraZeneca, personal fees and non-financial support from Tesaro/GSK, personal fees from Clovis, personal fees and non-financial support from Roche, personal fees from Incyte, and personal fees from Pfizer, other from ARCAGY-Research, outside the submitted work. D.S.P. Tan is supported by grants from the Singapore Ministry of Health's National Medical Research Council and Pangestu Family Foundation Gynaecological Cancer Research Fund. He also reports personal fees from AstraZeneca, Roche, MSD, Merck Serono, GSK, Tessa Therapeutics, Eisai, and Genmab, and research funding and support from AstraZeneca, Roche, Bayer, BMS, MSD, Eisai, and Karyopharm. He also reports stock ownership in the Asian Microbiome Library (AMiLi). All of these have been received outside the submitted work. A. Leary reports grants, personal fees, and non-financial support from AstraZeneca, Tesaro, and Clovis; grants and personal fees from MSD and Ability; personal fees from Biocad, Seattle Genetics, and Zentalis; other support from Merck Serono; and grants, non-financial support, and other from GSK, outside the submitted work. M.R. Mirza reports personal financial interests for AstraZeneca, Biocard, Clovis Oncology, Genmab, Karyopharm Therapeutics, Merck, Mersana, MSD, Oncology Venture, Pfizer, Roche, SeraPrognostics, Tesaro-GSK, ZaiLab; leadership roles for Karyopharm Therapeutics and Sera Prognostics; institutional financial interests (study grants) for AstraZeneca, Boehringer Ingelheim, Clovis Oncology, Pfizer, Tesaro-GSK, Ultimovacs. T. Enomoto reports personal fees from AstraZeneca, Takeda, MSD, and Chugai, outside the submitted work. J. Takyar has nothing to disclose. A.T. Nunes, J.D.H. Chagüi, and M.J. Paskow are employees and shareholders at AstraZeneca. B.J. Monk reports personal fees from AbbVie, Advaxis, Agenus, Amgen, AstraZeneca, Biodesix, Clovis, Conjupro, Genmab, Gradalis, ImmunoGen, Immunomedics, Incyte, Janssen/Johnson & Johnson, Mateon, Merck, Myriad, Perthera, Pfizer, Precision Oncology, Puma, Roche/Genentech, Samumed, Takeda, Tesaro, and VBL, outside the submitted work.