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. 2020 Jul 27;5(Suppl 3):e000827. doi: 10.1136/esmoopen-2020-000827

Table 6.

Cervical cancer: priorities in priorities in surgical, medical and radiation oncology care

High priority Medium Low
Surgical oncology

  • Radiologically confirmed bowel perforation, peritonitis.

  • Complications during/after radiotherapy for pelvic recurrence (fistulisation/bowel perforation).

  • Acute postsurgery complications (perforation, ureteral dissection).

  • Radical hysterectomy±BSO and lymphadenectomy stages IA2, IB1–IIA.

  • Trachelectomy (hysterectomy)±SLN sampling stage IA (postpone up to 2 months).

  • Repair of asymptomatic fistula.

  • CIN3 conisation (if appropriate).

  • Resection of slowly growing central recurrence.

  • Consider postponing total pelvic exenteration after the COVID-19 pandemic.
Medical oncology

  • Continuation of medical treatment in the context of a clinical trial.*

  • Stage IB3†, IIB–IVA ChT in association with radiotherapy (CRT).

  • Stage IVB first line, first local recurrence after >12 months from primary CRT: cisplatin/paclitaxel+bevacizumab (if not contraindicated). When cisplatin is contraindicated, consider carboplatin/paclitaxel or topotecan/paclitaxel with bevacizumab.

  • Continuation of standard ChT in case of confirmed significant benefit.

  • Second-line ChT according to clinical need, patient wishes and resource availability.
Radiation oncology

  • Pelvic EBRT in association with ChT (CRT) stage IB3, IIB–IVA.

  • Spinal cord compression, brain metastases, other critical metastatic lesions.

  • Salvage radiotherapy for symptomatic localised recurrence (central, retroperitoneal lymph nodes).

  • Palliative radiotherapy for asymptomatic recurrence not amenable to surgery.

*For patients on clinical trials, seek information about changes in management for individual studies from the coordinating trials unit for treatment frequency, blood investigations and imaging.

†2018 International Federation of Gynaecology and Obstetrics classification.

BSO, bilateral salpingo oophorectomy; ChT, chemotherapy; CIN, cervical intraepithelial neoplasia; CRT, chemoradiotherapy; EBRT, external beam radiation treatment; SLN, sentinel lymph node.