The recommendations that follow are those from the guideline's executive summary; detailed recommendations can be found in the original guideline document. Each recommendation is rated based on the level of the evidence and the grades of recommendation. Definitions of the grades of the recommendations (A, B, C, Good Practice Points) and level of the evidence (Level I-Level IV) are presented at the end of the Major Recommendations field.
Screening
B - To reduce the incidence and mortality rate of cervix cancer, effective screening and preventive strategy must be actively pursued, in addition to early detection of disease and effective therapy (Anderson et al., 1995; Laara, Day, & Hakama, 1987). (Grade B, Level IIa)
Stage IA
B - Total hysterectomy is the treatment of choice for microinvasive cervical cancer in patients who have completed their family. In selected patients, fertility-sparing surgery may be considered. (Grade B, Level III)
Stage IB – IIA
A - Current evidence indicates that both radical surgery and pelvic radiotherapy result in equivalent cure rates for early localized cervical cancer (Landoni et al., 1997). (Grade A, Level Ib)
A - The addition of post-operative treatment using a combination of chemotherapy and radiotherapy has been shown to improve survival outcome for patients with tumour involvement of pelvic lymph nodes, resection margins, and/or parametrial tissue (Sedlis et al., 1999; Peters et al., 2000). (Grade A, Level Ib)
The optimal treatment for bulky (>4cm) cervical cancer remains controversial.
Stage IIB – IVA
A - The treatment of choice for locally advanced cervical cancer is concurrent chemoradiation. (Grade A, Level Ia)
Metastatic Cancer
B - The main aim of treatment for patients with metastatic cancer is palliation of symptoms. (Grade B, Level IIa)
Recurrent Cancer
B - The treatment employed for patients with recurrent cervical cancer is dependent on their previous treatment modality and the exact anatomical site of relapse. (Grade B, Level IIa)
Ovarian Conservation
B - Ovarian conservation should be considered for young patients (Sutton et al., 1992). (Grade B, Level IIa)
Hormone Replacement Therapy
B - There is no clinical evidence that Hormone Replacement Therapy should be withheld from patients with a history of cervical cancer (Gadducci et al., 1997; Burger et al., 1999; Ploch, 1987; Sadan et al., 1989; Wren, 1994). (Grade B, Level IIa)
Definitions:
Grades of Recommendations
Grade A (evidence levels Ia, Ib): Requires at least one randomised controlled trial as part of the body of literature of overall good quality and consistency addressing the specific recommendation.
Grade B (evidence levels IIa, IIb, III): Requires availability of well conducted clinical studies but no randomised clinical trials on the topic of recommendation.
Grade C (evidence level IV): Requires evidence obtained from expert committee reports or opinions and/or clinical experiences of respected authorities. Indicates absence of directly applicable clinical studies of good quality.
Good Practice Points: Recommended best practice based on the clinical experience of the guideline development group.
Levels of Evidence
Level Ia: Evidence obtained from meta-analysis of randomised controlled trials.
Level Ib: Evidence obtained from at least one randomised controlled trial.
Level IIa: Evidence obtained from at least one well-designed controlled study without randomisation.
Level IIb: Evidence obtained from at least one other type of well-designed quasi-experimental study.
Level III: Evidence obtained from well-designed non-experimental descriptive studies, such as comparative studies, correlation studies and case studies.
Level IV: Evidence obtained from expert committee reports or opinions and/or clinical experiences of respected authorities.
