Evidence-based Guideline Diagnosis, Treatment, and Follow-Up in Patients with Cervical Carcinoma - Version 2.2 - March 2022

Oct 2, 2026

Uploaded by Adam

Evidence-based clinical guideline providing updated recommendations for diagnosis, treatment, and follow-up of patients with cervical carcinoma. The guideline highlights major revisions in Version 2.2 (March 2022), including updated FIGO classification handling, changes to surgical treatment recommendations and sentinel lymph node concepts, refinement of radiochemotherapy as a standard with emphasis on imaging-guided approaches, and updated strategies for recurrence and metastatic disease. It addresses imaging use (e.g., PET-CT timing) and drug therapy updates such as bevacizumab, carboplatin substitution, second-line options, and checkpoint inhibitors like pembrolizumab.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages295

Reading Time12 h 23 min

AccessFree to download

Important Updates

1. Information about this Guideline

1.1. Editors

1.2. Leading Scientific Societies

1.3. Funding of the Guideline

1.4. Contact

1.5. How to cite

1.6. Previous Changes

1.7. Special Comment

1.8. Objectives of the German Guideline Program in Oncology

1.9. Additional Documents relating to this Guideline

1.10. Composition of the Guideline Group

1.11. Abbreviations Used

2. Introduction

2.1. Scope and Purpose

Evidence-based Guideline Diagnosis, Treatment, and Follow-Up in Patients with Cervical Carcinoma Version 2.2 - March 2022 AWMF-Registernummer: 032/033OL Important Updates Major changes introduced by the guideline update (Version 2.0, 2021). New items include: • The new FIGO classification, published in 2018: This takes into account long-standing criticisms, such as integration of imaging and surgical procedures for diagnosis and the classification of para-ortic lymph nodes aspN1 instead of pM1 . However, due to the current lack of consistency between the (new) FIGO and the (old) TNM classification, the present revised version is still continuing to use the old version of the FIGO classification. Due to the new classification, which was first published in 2018, there are currently no data available from studies based on the new classification, so that the guideline group considered it justifiable to continue to use the old version. • Surgical treatments: Several studies have shown that open radical hysterectomy in patients with cervical carcinoma up to FIGO stage 1b1 is associated with better overall survival with abdominal methods rather than with minimally invasive methods. This aspect needed tobe revised and a corresponding recommendation has been made here to inform patients about the of the current state of the data. In addition, the concept of the sentinel lymph node has been included in tumors of up to 2 cm and in pT1a1 and L1 . Methodologically, it is also evident here that blue and radioactive marking are equivalent to intraoperative indocyanine green (ICG), so that the technique here has changed and the associated statements and recommendations have been revised accordingly. • Radio(chemo)therapy: In radiotherapy, radiochemotherapy has been further defined as the standard. The data on intensity-modulated radiotherapy and individualized MRI-guided brachytherapy, or image-guided adaptive brachytherapy, have been reemphasized. This is an obligatory component of treatment for cervical carcinoma patients and should be performed in a setting with planning on a single site. • Several studies have been carried out on imaging and drug therapy in the situation with recurrences and metastases: PET-CT is reserved for the recurrence situation before planned therapy such as exenteration or radiochemotherapy. In other situations, it should be performed only if the findings are unclear, but not routinely. In drug therapy, the addition of bevacizumab for first-line of primary recurrences and in metastatic therapy is now standard. In addition, cisplatin can be replaced equivalently by carboplatin in patients with prior platinum treatment. Cisplatin should continue to be prescribed in patients who have not previously received platinum. With regard to second-line therapies, information is available on nab-paclitaxel, vinorelbine, ifosfamide, topotecan, pemetrexed, and irinotecan. These can all be used for second-line treatment, although the research studies on them have not included comparisons with best-supportive care. Checkpoint inhibitors have been added as a new class of drugs. Pembrolizumab has been shown to be effective in PD-L1 positive carcinomas. If it is to be given, it should be administered in second-line treatment and not in the higher lines. Table of Contents Important Updates.................................................................................... 2 1. Information about this Guideline .................................................... 12 1.1. Editors ................................................................................................................................ 12 1.2. Leading Scientific Societies .................................................................................................. 12 1.3. Funding of the Guideline ..................................................................................................... 12 1.4. Contact .

FAQs

What are the key major updates in Version 2.0 (2021) that are incorporated into Version 2.2?

The update includes the new FIGO classification and explains why the guideline continues using the older FIGO due to inconsistency with TNM and limited new-classification study data. It also revises surgical, sentinel lymph node, radiochemotherapy, imaging, and drug-therapy recommendations.

How does the guideline update surgical and sentinel lymph node recommendations?

It revises surgical treatment information based on evidence favoring open radical hysterectomy with better overall survival for patients up to FIGO stage 1b1 compared with minimally invasive methods. It also includes the sentinel lymph node concept for tumors up to 2 cm and specifies methodological equivalence of blue/radioactive marking to ICG-related approaches.

What imaging and systemic therapy changes are recommended for recurrence and metastases?

PET-CT is reserved for recurrence situations before planned therapy such as exenteration or radiochemotherapy and is not recommended routinely when findings are unclear. For drug therapy, bevacizumab is now standard in first-line primary recurrences and metastatic therapy, cisplatin may be replaced by carboplatin after prior platinum treatment, and checkpoint inhibitors such as pembrolizumab are added for PD-L1 positive carcinomas in second-line rather than later.

Oct 2, 2026

Uploaded by Adam