Gynecologic Oncology Center, Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University, General University Hospital, Prague, Czech Republic.
Department of Oncology and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
Int J Gynecol Cancer. 2018 Jul;28(6):1226-1231. doi: 10.1097/IGC.0000000000001314.
The aim of this survey was to acquire an overview of the current management of cervical cancer with an emphasis on the early disease stages.
A hyperlink to the survey was sent to the European Society of Gynaecological Oncology Office database. The survey contained 6 groups of questions regarding the characteristics of respondents, pretreatment workup, management of the early stages of cervical cancer, adjuvant treatment, fertility-sparing treatment, and surveillance.
In total, 566 responses were collected. The most frequent imaging method used in the workup was magnetic resonance imaging (74%), followed by computed tomography (54%) and positron emission tomography/computed tomography (25%). Conization or simple hysterectomy was a preferred procedure in stage T1a1 lymphovascular space invasion (LVSI)-positive for 79% of respondents, in stage T1a2 LVSI-negative for 58%, and in stage T1a2 LVSI-positive for 28%. Sentinel lymph node biopsy alone was reported in stage T1a1 by 17% and in stage T1b1 less than 2 cm by 9%, whereas systematic lymphadenectomy by 29% and 90% of respondents. Macrometastases, micrometastases, and isolated tumor cells in lymph nodes were considered indications for adjuvant treatment by 96%, 93%, and 68% of respondents, respectively. Neoadjuvant chemotherapy was reported by 28% and 19% of respondents in fertility-sparing and nonsparing management in stage T1b1. Over 60% of respondents recommend primary surgery for their patients with T1b2 N0 disease and 81% of them use a combination of adverse prognostic factors as indication for adjuvant radiotherapy in pN0 disease.
The results of this survey indicate considerable differences in the workup and treatment of cervical cancer in current clinical practice.
本调查旨在概述宫颈癌的当前管理，重点关注早期疾病阶段。
向欧洲妇科肿瘤学会办公室数据库发送了调查的超链接。该调查包含 6 组问题，涉及受访者的特征、预处理检查、宫颈癌早期的管理、辅助治疗、保留生育力的治疗和监测。
共收集了 566 份回复。在预处理检查中最常使用的影像学方法是磁共振成像（74%），其次是计算机断层扫描（54%）和正电子发射断层扫描/计算机断层扫描（25%）。对于 LVSI 阳性的 T1a1 期（79%的受访者）、LVSI 阴性的 T1a2 期（58%的受访者）和 LVSI 阳性的 T1a2 期（28%的受访者），锥切术或单纯子宫切除术是首选方法。单独的前哨淋巴结活检在 T1a1 期的报告率为 17%，在 T1b1 期<2cm 的报告率为 9%，而系统淋巴结清扫术的报告率分别为 29%和 90%。96%、93%和 68%的受访者分别认为淋巴结中有大转移灶、微转移灶和孤立肿瘤细胞是辅助治疗的指征。28%和 19%的受访者在 T1b1 期的保留生育力和非保留生育力管理中报告了新辅助化疗。超过 60%的受访者建议对 T1b2N0 疾病的患者进行主要手术，81%的患者在 pN0 疾病中使用不良预后因素组合作为辅助放疗的指征。
本调查结果表明，当前临床实践中宫颈癌的检查和治疗存在相当大的差异。
