Cervical_cancer-NCCN-2011.pdf
Cervical_cancer-NCCN-2011.pdf
Version 1.2011, 10/06/10 © National Comprehensive Cancer Network, Inc. 2010, All rights reserved. The NCCN Guidelines™ and this illustration may not be reproduced in any form without the express written permission of NCCN®.
NCCN Guidelines Index
Cervical Cancer TOC
Discussion
NCCN.org
Continue
Version 1.2011
NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines™)
Cervical Cancer
Version 1.2011, 10/06/10 © National Comprehensive Cancer Network, Inc. 2010, All rights reserved. The NCCN Guidelines™ and this illustration may not be reproduced in any form without the express written permission of NCCN®.
NCCN Guidelines Index
Cervical Cancer TOC
Discussion
NCCN Guidelines™ Version 1.2011 Panel Members
Cervical Cancer
Continue
NCCN Guidelines Panel Disclosures
*
*
Benjamin E. Greer, MD/Co-Chair
Fred Hutchinson Cancer Research
Center/Seattle Cancer Care Alliance
Wui-Jin Koh, MD/Co-Chair
Fred Hutchinson Cancer Research
Center/Seattle Cancer Care Alliance
Kathleen R. Cho, MD
University of Michigan
Comprehensive Cancer Center
Larry Copeland, MD
The Ohio State University Comprehensive
Cancer Center - James Cancer Hospital
and Solove Research Institute
§
†
Nadeem R. Abu-Rustum, MD
Memorial Sloan-Kettering Cancer Center
Sachin M. Apte, MD, MS
H. Lee Moffitt Cancer Center
& Research Institute
Susana M. Campos, MD, MPh, MS
Dana-Farber/Brigham and Women’s
Cancer Center
John Chan, MD
UCSF Helen Diller Family
Comprehensive Cancer Center
Marta Ann Crispens, MD
Vanderbilt-Ingram Cancer Center
Nefertiti DuPont, MD, MPH
Roswell Park Cancer Institute
Patricia J. Eifel, MD
The University of Texas
MD Anderson Cancer Center
Warner K. Huh, MD
Lainie Martin, MD
Fox Chase Cancer Center
§
§
§
†
David K. Gaffney, MD, PhD
Huntsman Cancer Institute
at the University of Utah
Daniel S. Kapp, MD, PhD
Stanford Comprehensive Cancer Center
John R. Lurain, III, MD
Robert H. Lurie Comprehensive Cancer
Center of Northwestern University
University of Alabama at Birmingham
Comprehensive Cancer Center
Mark A. Morgan, MD
Fox Chase Cancer Center
Robert J. Morgan, Jr., MD
City of Hope Comprehensive
Cancer Center
Nelson Teng, MD, PhD
Stanford Comprehensive Cancer Center
Fidel A. Valea, MD
Duke Comprehensive Cancer Center
† ‡
§
David Mutch, MD
Siteman Cancer Center at Barnes-
Jewish Hospital and Washington
University School of Medicine
Steven W. Remmenga, MD
UNMC Eppley Cancer Center at
The Nebraska Medical Center
R. Kevin Reynolds, MD
University of Michigan
Comprehensive Cancer Center
William Small, Jr., MD
Robert H. Lurie Comprehensive Cancer
Center of Northwestern University
Gynecologic oncology
† Medical oncology
‡ Hematology
§ Radiotherapy/Radiation oncology
Pathology
* Writing committee member
NCCN
Miranda Hughes, PhD
Nicole McMillian, MS
Printed by WANG Yongjun on 5/9/2011 10:37:13 PM. For personal use only. Not approved for distribution. Copyright © 2011 National Comprehensive Cancer Network, Inc., All Rights Reserved.
Version 1.2011, 10/06/10 © National Comprehensive Cancer Network, Inc. 2010, All rights reserved. The NCCN Guidelines™ and this illustration may not be reproduced in any form without the express written permission of NCCN®.
NCCN Guidelines Index
Cervical Cancer TOC
Discussion
Clinical Trials:
Categories of Evidence and
Consensus:
NCCN
All recommendations
are Category 2A unless otherwise
specified.
The
believes that the best management
for any cancer patient is in a clinical
trial. Participation in clinical trials is
especially encouraged.
NCCN
To find clinical trials online at NCCN
member institutions, click here:
nccn.org/clinical_trials/physician.html
See NCCN Categories of Evidence
and Consensus
The NCCN Guidelines™ are a statement of evidence and consensus of the authors regarding their views of currently accepted approaches to
treatment. Any clinician seeking to apply or consult the NCCN Guidelines is expected to use independent medical judgment in the context of individual
clinical circumstances to determine any patient’s care or treatment. The National Comprehensive Cancer Network® (NCCN®) makes no
representations or warranties of any kind regarding their content, use or application and disclaims any responsibility for their application or use in any
way. The NCCN Guidelines are copyrighted by National Comprehensive Cancer Network®. All rights reserved. The NCCN Guidelines and the
illustrations herein may not be reproduced in any form without the express written permission of NCCN. ©2010.
NCCN Cervical Cancer Panel Members
Summary of the Guidelines Updates
Clinical Stage (CERV-1)
Stage IA1, IA2 (CERV-2)
Stage IB1 and Stage IIA1 (CERV-2)
Stage IB2 and Stage IIA2 (CERV-2)
Stage IB2, IIA2, and Stages IIB, IIIA, IIIB, IVA (CERV-4)
Incidental finding of invasive cancer at simple hysterectomy (CERV-7)
Surveillance (CERV-8)
Local/regional recurrence (CERV-9)
Distant metastases (CERV-10)
Principles of Radiation Therapy for Cervical Cancer (CERV-A)
Chemotherapy Regimens for Recurrent or Metastatic Cervical Cancer (CERV-B)
Staging (ST-1)
NCCN Guidelines™ Version 1.2011
Cervical Cancer
Table of Contents
The NCCN Cervical Cancer Guidelines include the management of squamous cell carcinoma,
adenosquamous carcinoma, and adenocarcinoma of the cervix.
Printed by WANG Yongjun on 5/9/2011 10:37:13 PM. For personal use only. Not approved for distribution. Copyright © 2011 National Comprehensive Cancer Network, Inc., All Rights Reserved.
Version 1.2011, 10/06/10 © National Comprehensive Cancer Network, Inc. 2010, All rights reserved. The NCCN Guidelines™ and this illustration may not be reproduced in any form without the express written permission of NCCN®.
NCCN Guidelines Index
Cervical Cancer TOC
Discussion
UPDATES
NCCN Guidelines™ Version 1.2011 Updates
Cervical Cancer
Updates in Version 1.2011 of the NCCN Cervical Cancer Guidelines from Version 1.2010 include:
Global Changes:
The Staging tables were updated to reflect the 2009 FIGO Staging and .
The Cervical Cancer algorithms were revised to reflect the new FIGO staging.
( ) ( )ST-1 ST-2
“Principles of Radiation Therapy” is a new page that provides specific recommendations and dosing for radiation therapy throughout the
NCCN Cervical Cancer Guidelines .( )CERV-A
CERV-1
CERV-2
CERV-3
CERV-5
CERV-4
Workup: The “CBC” and “Imaging” bullets were revised for clarity.
(Also for )
Stage IA1; Primary Treatment: The third option changed to
“Modified radical hysterectomy + pelvic lymph
node dissection if lymphovascular invasion (category 2B
)”.
Stage IA2; Primary Treatment: The second option changed from
“Brachytherapy + pelvic RT...” to “Brachytherapy ± pelvic RT...”
Stage IB1 and stage IIA1; Primary treatment: “Radical
trachelectomy for fertility preservation for lesions (Stage IB1)...”
changed to “Radical trachelectomy for
(Stage IB1)...”
Surgical Findings: “Positive pelvic nodes or Positive surgical
margin or Positive parametrium” changed to “Positive pelvic
nodes /or Positive surgical margin /or Positive
parametrium” (Also for )
Para-aortic lymph node postive...”; Bottom pathway:
Radiologic imaging only; Positive adenopathy: “FNA if clinically
indicated” changed to “Consider needle biopsy”.
“Pelvic lymph node positive/para-aortic lymph....” changed to
“Pelvic lymph node positive and para-aortic lymph node...”
CERV-7
or trachelectomy
for node
dissection
tumors 2 cm
and and
CERV-7
“Chest CT/PET scan” was clarified as “Chest CT or PET-CT
scan”.
“Systemic therapy/individualized RT” changed to “Systemic
therapy ± individualized RT”. (Also for and )CERV-5 CERV-6
CERV-6
CERV-7
CERV-8
CERV-9
CERV-10
CERV-B
“Retroperitoneal lymph node dissection” changed to “ peritoneal
lymph node dissection”.
Surveillance: “Patient education regarding symptoms” was added.
Workup: “Pelvic/abdominal/chest CT/PET scan” changed to
“Additional imaging as clinically indicated”.
Footnote “h” regarding PET-CT scan is new to the page.
Noncentral disease: “Pelvic exenteration” was removed before
“Resection with IORT for close or positive margins”.
“Platinum-based chemotherapy” changed to “Chemotherapy”.
Resectable: “RT + concurrent chemotherapy” changed to “RT ±
concurrent chemotherapy”.
Chemotherapy Regimens for Recurrent or Metastatic Disease
First-line combination therapy: “Cisplatin/paclitaxel” changed from
“category 1” to “category 2A”.
Second-line therapy:
Statement changed to “Agents listed are category 2B
”.
“Epirubicin” and “liposomal doxorubicin” were removed.
“Pemetrexed” and “vinorelbine” changed from “category 2B” to
“category 3.”
Extra
unless
otherwise noted
”Stage IA1 with lymphovascular space invasion” pathway: “Optional
( Stage IB2): EUA cystoscopy/proctoscopy” was removed as a
recommendation.
Footnote referencing the page
from the is new to the page.
Management of Drug Reactions (OV-C
NCCN Ovarian Cancer Guidelines
)
Printed by WANG Yongjun on 5/9/2011 10:37:13 PM. For personal use only. Not approved for distribution. Copyright © 2011 National Comprehensive Cancer Network, Inc., All Rights Reserved.
Version 1.2011, 10/06/10 © National Comprehensive Cancer Network, Inc. 2010, All rights reserved. The NCCN Guidelines™ and this illustration may not be reproduced in any form without the express written permission of NCCN®.
NCCN Guidelines Index
Cervical Cancer TOC
Discussion
Note: All recommendations are category 2A unless otherwise indicated.
Clinical Trials: NCCN believes that the best management of any cancer patient is in a clinical trial. Participation in clinical trials is especially encouraged.
WORKUP
Stage IA1
Stage IA2
Stage IB1
Stage IIA1
Stage IB2
Stage IIA2
Incidental finding of invasive
cancer at simple hysterectomy
H&P
CBC (including platelets)
Cervical biopsy, pathologic
review
Cone biopsy as indicated
LFT/renal function studies
Imaging
(optional for stage IB1):
Chest x-ray
CT or PET-CT scan
MRI as indicated
EUA cystoscopy/proctoscopy
a
Optional ( Stage IB2):
b
CLINICAL STAGE
Stage IIB
Stage IIIA, IIIB
Stage IVA
See Primary Treatment (CERV- 2)
See Primary Treatment (CERV-2)
See Primary Treatment
(CERV-2 ) and (CERV-4)
See Primary Treatment (CERV-4)
See Primary Treatment (CERV-7)
aSee Discussion for indications for cone biopsy .
bFor suspicion of bladder/bowel involvement, cystoscopy/proctoscopy with biopsy is required.
(MS-2)
All staging in guideline is based on updated 2009 FIGO staging. (See ST-1)
CERV-1
NCCN Guidelines™ Version 1.2011
Cervical Cancer
Printed by WANG Yongjun on 5/9/2011 10:37:13 PM. For personal use only. Not approved for distribution. Copyright © 2011 National Comprehensive Cancer Network, Inc., All Rights Reserved.
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