Akladios Cherif, Azais Henri, Ballester Marcos, Bendifallah Sofiane, Bolze Pierre-Adrien, Bourdel Nicolas, Bricou Alexandre, Canlorbe Geoffroy, Carcopino Xavier, Chauvet Pauline, Collinet Pierre, Coutant Charles, Dabi Yohann, Dion Ludivine, Gauthier Tristan, Graesslin Olivier, Huchon Cyrille, Koskas Martin, Kridelka Frederic, Lavoue Vincent, Lecointre Lise, Mezzadri Matthieu, Mimoun Camille, Ouldamer Lobna, Raimond Emilie, Touboul Cyril
Service de gynécologie, CHU de Hautepierre, 67000 Strasbourg, France.
Service de gynécologie, Hopital la Pitié Salpetriee, 75013 Paris, France.
J Gynecol Obstet Hum Reprod. 2020 Jun;49(6):101729. doi: 10.1016/j.jogoh.2020.101729. Epub 2020 Apr 1.
In the context of the COVID-19 pandemic, specific recommendations are required for the management of patients with gynecologic cancer.
The FRANCOGYN group of the National College of French Gynecologists and Obstetricians (CNGOF) convened to develop recommendations based on the consensus conference model.
If a patient with a gynecologic cancer presents with COVID-19, surgical management should be postponed for at least 15 days. For cervical cancer, radiotherapy and concomitant radiochemotherapy could replace surgery as first-line treatment and the value of lymph node staging should be reviewed on a case-by-case basis. For advanced ovarian cancers, neoadjuvant chemotherapy should be preferred over primary cytoreduction surgery. It is legitimate not to perform hyperthermic intraperitoneal chemotherapy during the COVID-19 pandemic. For patients who are scheduled to undergo interval surgery, chemotherapy can be continued and surgery performed after 6 cycles. For patients with early stage endometrial cancer of low and intermediate preoperative ESMO risk, hysterectomy with bilateral adnexectomy combined with a sentinel lymph node procedure is recommended. Surgery can be postponed for 1-2 months in low-risk endometrial cancers (FIGO Ia stage on MRI and grade 1-2 endometrioid cancer on endometrial biopsy). For patients of high ESMO risk, the MSKCC algorithm (combining PET-CT and sentinel lymph node biopsy) should be applied to avoid pelvic and lumbar-aortic lymphadenectomy.
During the COVID-19 pandemic, management of a patient with cancer should be adapted to limit the risks associated with the virus without incurring loss of chance.
在2019冠状病毒病大流行的背景下，需要针对妇科癌症患者的管理提出具体建议。
法国国家妇产科医生学院（CNGOF）的FRANCOGYN小组召开会议，根据共识会议模式制定建议。
如果妇科癌症患者感染了2019冠状病毒病，手术治疗应至少推迟15天。对于宫颈癌，放疗和同步放化疗可替代手术作为一线治疗，淋巴结分期的价值应逐案审查。对于晚期卵巢癌，新辅助化疗应优先于初次肿瘤细胞减灭术。在2019冠状病毒病大流行期间不进行热灌注化疗是合理的。对于计划接受间隔期手术的患者，化疗可以继续，6个周期后进行手术。对于术前ESMO风险低和中等的早期子宫内膜癌患者，建议行子宫切除术加双侧附件切除术并联合前哨淋巴结手术。低风险子宫内膜癌（MRI上为FIGO Ia期，子宫内膜活检为1-2级子宫内膜样癌）的手术可推迟1-2个月。对于ESMO高风险患者，应采用MSKCC算法（结合PET-CT和前哨淋巴结活检）以避免盆腔和腹主动脉旁淋巴结清扫术。
在2019冠状病毒病大流行期间，癌症患者的管理应进行调整，以限制与病毒相关的风险，同时不造成机会丧失。
