The American Society for Radiation Oncology (ASTRO) issued a new clinical guideline with recommendations for external beam radiation, chemoradiation, and brachytherapy for postoperative and definitive management of non-metastatic cervical cancer.
ASTRO convened a task force to address five key questions pertaining to the use of radiotherapy in cervical cancer, including indications for postoperative and definitive radiotherapy, use of chemotherapy in sequence or concurrence with radiotherapy, use of intensity modulated radiation therapy (IMRT), and indications and techniques of brachytherapy.
Recommendations are based on a systematic literature review, consensus, and system for grading evidence quality and recommendation strength. The guideline was published in Practical Radiation Oncology (online May 18, 2020; doi:10.1016/j.prro.2020.04.002).
The task force recommends postoperative radiotherapy for patients with intermediate-risk factors, as well as chemoradiation for those with high-risk factors. In the definitive setting, chemoradiation is recommended for stage IB3-IVA disease, and radiotherapy or chemoradiation is conditionally recommended for stage IA1-IB2 disease if deemed medically inoperable.
IMRT is recommended for postoperative radiotherapy and conditionally recommended for definitive radiotherapy – for reducing acute and late toxicity.
Additionally, the guideline states that brachytherapy is strongly recommended for all patients receiving definitive radiotherapy. Several recommendations are listed for target dose and fractionation, use of intraoperative imaging, volume-based planning, and dose limiting for organs at risk.
“The issues facing women with cervical cancer are unique. Doing everything we can to eliminate the tumor is only part of our job,” stated Junzo Chino, MD, associate professor of radiation oncology, Duke University Cancer Center, and vice chair of the guideline task force, in a press release (June 10, 2020). “The other part is to make sure that patients are doing well throughout the treatment process.”—Zachary Bessette