ASTRO Reveals First Cervical Cancer Guidelines

June 12, 2020

Guidelines, supported by several medical societies, offer direction for post-operative and “definitive” settings.

This week, the American Society for Radiation Oncology (ASTRO) released its first clinical guidelines for using radiation therapy to treat patients who have non-metastatic cervical cancer.

The guidelines, published in Practical Radiation Oncology, discuss best practices for using external-beam radiation therapy (EBRT) and brachytherapy in both post-operative and “definitive” settings. This guidance also touches on using chemotherapy and surgery in combination with radiation treatments, as well as intensity-modulated radiation therapy (IMRT).

"Cervical cancer treatment has advanced dramatically over the last 20 years. Increased use of intensity-modulated radiation therapy (IMRT) and image-guided brachytherapy, in particular, have resulted in better patient outcomes and fewer treatment complications," said Akila N. Viswanathan, M.D., MPH, guideline task force chair and professor and interim director of radiation oncology and molecular radiation sciences at the Johns Hopkins Sidney Kimmel Cancer Center in Baltimore. "Our intention in developing this guideline is to encourage physicians to make these approaches part of their daily practice." 

A multi-disciplinary panel reviewed scientific articles published from January 1993 to October 2018 to draft the guidelines. And, several societies, including the Canadian Association of Radiation Oncology, the European Society for Radiotherapy and Oncology, and the Society of Gynecologic Oncology have endorsed them.

Specific recommendations for locally advanced cancer were:

  • Using radiation with concurrent platinum-based chemotherapy for patients with high-risk factors after radical hysterectomy in the post-operative setting.

  • Using radiation therapy with patients who have intermediate-risk factors in post-operative settings.

  • IMRT when performing EBRT in post-operative settings.

  • Using brachytherapy for patients who are also receiving radiation or chemoradiation in the definitive setting.

  • Providing chemoradiation therapy for patients who have stage IB3-IVA cancers, following the International Federation of Gynecology and Obstetrics (FIGO) guidelines in the definitive setting.

Additionally, the guidelines conditionally recommended implementing radiation or chemoradiation in definitive setting for patients with FIGO stage IA1-IB2 cancers who are unable to undergo surgery, brachytherapy for patients with positive margins, and IMRT alongside EBRT in the definitive setting.

It is important to note, Viswanathan cautioned, that these guidelines were drafted prior to the COVID-19 pandemic so they do not address the virus or any impact it might have on cervical cancer treatment. However, the guidelines task force did caution against postponing cervical cancer treatment during the outbreak.

“Cervical cancer is one of those cancers where you just can’t wait,” she said. "You need to treat it right away in order to have the greatest chance of cure."