Management and Care of Women With Invasive Cervical Cancer: American Society of Clinical Oncology Resource-Stratified Clinical Practice Guideline.
Management and Care of Women With Invasive Cervical Cancer: American Society of Clinical Oncology Resource-Stratified Clinical Practice Guideline.
复制标题
DOI：
10.1200/jgo.2016.003954
复制
发表时间：
2016-10
影响因子：
--
通讯作者：
Berek JS
中科院分区：
文献类型：
--
作者：
Chuang LT;Temin S;Camacho R;Dueñas-Gonzalez A;Feldman S;Gultekin M;Gupta V;Horton S;Jacob G;Kidd EA;Lishimpi K;Nakisige C;Nam JH;Ngan HYS;Small W;Thomas G;Berek JS
为临床医生和政策制定者提供基于证据、资源分层的全球建议，以指导诊断为浸润性宫颈癌的女性的管理和姑息治疗。 ASCO 召集了一个由癌症控制、医学和放射肿瘤学、卫生经济学、妇产科和姑息治疗专家组成的多学科、多国专家小组，提出反映资源分级环境的建议。对 1966 年至 2015 年文献的系统回顾未能产生足够有力的高质量证据来支持基本和有限资源设置建议；采用基于共识的正式流程来制定建议。还使用修改后的 ADAPTE 流程来调整现有指南中的建议。确定并审查了五套现有指南，并根据证据基础提出了改编的建议。八项系统评价以及成本效益分析为共识过程提供了间接证据，最终达成了 75% 或更高的共识。临床医生和规划者应努力提供最有效的循证抗肿瘤和姑息治疗干预措施。如果女性无法在自己或邻国或地区获得这些服务，她可能需要接受较低级别的治疗，具体取决于手术、化疗、放射治疗以及支持性和姑息治疗的能力和资源。对于基本情况下患有早期宫颈癌的女性，可以进行锥形活检或筋膜外子宫切除术。在非基础环境中，保留生育能力的手术或改良根治性或根治性子宫切除术可能是额外的选择。对于 IB 至 IVA 期疾病的女性，应根据可用资源，结合手术、化疗和放射治疗（包括近距离放射治疗）。疼痛控制是姑息治疗的重要组成部分。更多信息请访问 www.asco.org/rs-cervical-cancer-treatment-guideline 和 www.asco.org/guidelineswiki。 ASCO 认为，医疗保健提供者和医疗保健系统决策者应遵循针对最高可用资源层的建议。该指南旨在补充但不取代当地指南。
To provide evidence-based, resource-stratified global recommendations to clinicians and policymakers on the management and palliative care of women diagnosed with invasive cervical cancer. ASCO convened a multidisciplinary, multinational panel of cancer control, medical and radiation oncology, health economic, obstetric and gynecologic, and palliative care experts to produce recommendations reflecting resource-tiered settings. A systematic review of literature from 1966 to 2015 failed to yield sufficiently strong quality evidence to support basic- and limited-resource setting recommendations; a formal consensus-based process was used to develop recommendations. A modified ADAPTE process was also used to adapt recommendations from existing guidelines. Five existing sets of guidelines were identified and reviewed, and adapted recommendations form the evidence base. Eight systematic reviews, along with cost-effectiveness analyses, provided indirect evidence to inform the consensus process, which resulted in agreement of 75% or greater. Clinicians and planners should strive to provide access to the most effective evidence-based antitumor and palliative care interventions. If a woman cannot access these within her own or neighboring country or region, she may need to be treated with lower-tier modalities, depending on capacity and resources for surgery, chemotherapy, radiation therapy, and supportive and palliative care. For women with early-stage cervical cancer in basic settings, cone biopsy or extrafascial hysterectomy may be performed. Fertility-sparing procedures or modified radical or radical hysterectomy may be additional options in nonbasic settings. Combinations of surgery, chemotherapy, and radiation therapy (including brachytherapy) should be used for women with stage IB to IVA disease, depending on available resources. Pain control is a vital component of palliative care. Additional information is available at www.asco.org/rs-cervical-cancer-treatment-guideline and www.asco.org/guidelineswiki. It is the view of ASCO that health care providers and health care system decision makers should be guided by the recommendations for the highest stratum of resources available. The guideline is intended to complement but not replace local guidelines.