RT Book, Section
A1 Salvo, Gloria
A1 Salcedo, Mila P.
A1 Basabe, Sol
A1 Ramirez, Pedro T.
A2 Kantarjian, Hagop M.
A2 Wolff, Robert A.
A2 Rieber, Alyssa G.
SR Print(0)
ID 1190837292
T1 Tumors of the Uterine Cervix
T2 The MD Anderson Manual of Medical Oncology, 4e
YR 2022
FD 2022
PB McGraw Hill Education
PP New York, NY
SN 9781260467642
LK accessmedicine.mhmedical.com/content.aspx?aid=1190837292
RD 2024/04/24
AB KEY  CONCEPTSCancer  of  the  cervix  is  the  third  most  common  gynecologic  malignancy  in  the  United  States.  The  American  Cancer  Society  estimated  that  there  would  be  a  total  of  13,800  new  cases  of  invasive  cervical  cancer  and  4290  deaths  in  2020.The  nonavalent  vaccine  (Gardasil-9),  which  targets  HPV-6,  -11,  -16,  -18,  -31,  -33,  -45,  -52,  and  -58,  is  recommended  to  both  boys  and  girls  between  the  ages  of  11  and  12  years  old.  A  two-dose  schedule  with  a  6-  12-month  interval  between  doses  is  recommended  if  given  before  age  15  years.  For  people  older  than  15  years  old  or  immunocompromised,  three  doses  are  required  (0,  1–2,  and  6  months).The  2018  revised  International  Federation  of  Gynecology  and  Obstetrics  (FIGO)  staging  system  main  changes  from  the  previous  2009  are  the  allowance  of  images  and  pathology,  when  available  to  allocate  the  stage.  For  stage  IA  only,  depth  of  invasion  (≤3  mm  and  >3  mm  and  ≤5  mm)  is  now  considered  to  allocate  a  tumor  as  IA1  or  IA2,  respectively,  because  horizontal  extent  is  no  longer  contemplated.  Stage  IB  tumors  are  now  divided  according  to  their  greatest  dimension  into  IB1  (≤2  cm),  IB2  (>2  cm  and  ≤4  cm),  and  IB3  (>4  cm).  Nodal  compromise  is  now  considered  part  of  the  staging  system.  Positive  pelvic  nodes  are  now  allocating  as  IIIC1  and  positive  paraaortic  nodes  are  considered  stage  IIIC2.Radical  hysterectomy  with  pelvic  lymphadenectomy  is  the  standard  treatment  for  early-stage  cervical  cancer  (FIGO  2018  IA2-IB2).  After  the  results  of  a  prospective  randomized  trial  showing  that  minimally  invasive  surgery  was  associated  with  higher  rates  of  locoregional  recurrences  (hazard  ratio  [HR],  4.26;  95%  confidence  interval  [CI],  1.44-12.6;  P  =  .009)  and  higher  risk  of  death  (HR:  6.00;  95%  CI,1.77–20.3;  P  =  .004],  minimally  invasive  surgery  is  no  longer  recommended.First-line  therapy  recommended  for  recurrent  of  metastatic  disease  is  cisplatin,  paclitaxel,  and  bevacizumab.  The  Gynecologic  Oncology  Group  240  randomized  trial  showed  that  the  addition  of  bevacizumab  resulted  in  a  significant  improvement  in  overall  survival  compared  with  chemotherapy  alone  (median,  16.8  vs  13.3  months,  respectively;  HR,  0.77;  98%  CI,  0.62–0.95).Pembrolizumab  is  the  preferred  regimen  for  second-line  therapy  in  patients  with  recurrent  or  metastatic  disease  who  are  tumor  programmed  death-ligand  1  with  an  overall  response  rate  as  showed  by  the  KEYNOTE-028  trial  of  17%  and  duration  of  response  was  5.4  months.