Cervical Treatment Guidlines
Table of Contents
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GENERAL TREATMENT GUIDELINES
- Complete treatment within 8 weeks.
- All patients who are medically fit and stage ≥IB2 should probably get concurrent cisplatin-based chemo and RT.
- AdenoCa probably should not get chemo, outcome is same as SCCA stage for stage. Most ACA are younger who do worse
Treatment by Stage
== Surgeries for Cervical Cancer ==
Stage O:
TAH or conization in young women
Stage Ia1
Conization or Simple Hysterectomy IA1
- Less than 1% risk of LN metastasis.
- If the depth of invasionis < 3mm, no LVI, and margins (-). No further treatment.
Intracavitary radiation alone for IA1
- < 3mm depth of invasion, no LVI.
- T&O x 2 to 65-75 Gy to point A
- Maximal vaginal surface dose of 100 to 120 Gy.
Stage Ia2, Ib1 and IIa (< 4 cm)
Radical Hysterectomy for IA2 or IB1 (category 1)
- 3-5 mm depth has upto 10% risk of LN.(+).
- Radical Hys + LN dissection for uncertain tumor invasion.
External 45 Gy + T&O x 2 for a point A dose of ≥ 85 Gy. (category 2B)
No chemotherapy needed (no evidence for it) for IA2 or IB1
Stage Ib2/IIa (> 4 cm)
Definitive Chemoradiation (category 1)
- Pelvic 45 Gy + T&O x 2 for a point A dose of ≥ 85 Gy.
- Local control 80%
Radical Hysterectomy and bilateral pelvic Lymphadenectomy (category 2B)
- Local control 60% with surgery alone
- Postoperative total pelvic irradiation + chemotherapy for pelvic nodes(+), margin(+), and residual parametrial disease (Landoni)
Stage IIb/III/Iva
Definitive Chemoradiation (category 1)
- pelvic 45 Gy + T&O x 2 for a point A dose of ≥ 85 Gy.
- See special cases
SPECIAL SITUATIONS
- (LEFT A) Example of left parametrial implant used to boost the dose in a patient in whom only an afterloading tandem was placed in combination with whole pelvis and parametrial irradiation fro treatment of stage IIB carcinoma of the cervix
- (RIGHT B) Example of aferloading iridium implant used to boost the right paravaginal and parametrial tissues in a patient with stage IIIB carcinoma of the cervix
Parametrial residual after external beam (II b.)
- Parametrial boost to 54 to 66 Gy (see Parametrial boost section)
- Need to keep bowel < 45 Gy
- If extensive parametrial residual consider interstitial
- The T&O is prescribed to 2 cm from the os up and out, point A, so you could still treat disease up to this point with a standard T&O.
- If tumor is not covered by 80-85 Gy with T&O, then interstitial implant
- The response is measured after 5 weeks of Chemo RT ( I always do a CT, MRI PREFERABLE). With Cispt now being added concurrently there is a tendency for the platelets to bottom out. We and others have noticed that this plateau tends to occur at 5 weeks, no published data, so doing a Syed is not without significant risks. Make sure you have a platelet draw the morning of the procedure (best), or the day before and look for a value of at least 100.
- Another option if there is little response after 5 weeks of Chemo RT is a Rad Hys, but only after you mentioned the Syed… a Rad Onc exam.
Distal vaginal residual (III a.)
- if < 5 mm of depth then tandem and cylinder to 85 Gy to vaginal mucosa
- if > 5 mm of depth interstitial implants to 85 Gy to tumor volume while respecting vaginal tolerance
- inguinal covered by external beam
Para-aortic (not part of WHO staging)
== Para-aortic Radiation ==
page revision: 15, last edited: 15 May 2008 17:22