Page 103 - CPG มะเร็งปากมดลูก

Neck/chest/abdomen/pelvis/groin FDG-PET/CT ? brain MRI (preferred) or Chest/abdomen/pelvis CT ? brain MRI

Disease confine to the cervix Locally advanced disease Metastatic or recurrence disease แนวทางการปอ? งกันและรกั ษามะเรง็ ปากมดลกู

Tumor ? 4 cm Tumor >4 cm Local therapy Not amenable แผนภูมทิ ี่ 1 แนวทางการรักษาผป?ู ว? ยมะเร็งปากมดลกู ชนิด SCNEC

Primary RH + PLND CCRT+BT NAC CCRT+BT NAC follow Resection ? RT / Systemic therapy
treatment ? PALND ?CMT by CCRT+BT Local ablative therapy ? ? BSC

Persist or recurrence RT / RT ? CCRT

Adjuvant CMT / Systemic RH RH not Local disease Distant metastatic disease
treatment CCRT* therapy CCRT+BT
RT /
CCRT+BT Systemic therapy / BSC /
pelvic exenteration

Surveillance History taking, pelvic examination, cervical/ vaginal cytology screening, laboratory assessment and patient education were the same as other types of cervical cancer
Imaging for treatment response or surveillance: Neck/chest/abdomen/pelvis/groin FDG-PET/CT ? brain MRI or Chest/abdomen/pelvis CT ? brain MRI

ดัดแปลงจาก Cervical Cancer: NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines?); 2024 [updated September 20, 2023. Version 1.2024] 97

*Concurrently cisplatin (or carboplatin) + etoposide with RT (on days 1 and 22).and subsequent two cycles are given after RT

BST = best supportive care, BT = brachytherapy, CCRT = concurrent chemoradiation (radiation with cisplatin/carboplatin + etoposide), CMT = chemotherapy (cisplatin / carboplatin + etoposide), NAC =
neoadjuvant chemotherapy, PALND = paraaortic lymphadenectomy, PLND = pelvic lymphadenectomy, RH = radical hysterectomy, RT = radiation