Page 26 - ARNM-3-1

Advances in Radiotherapy
& Nuclear Medicine Chinese Expert Consensus for LACC

11 Obstetrics and Gynecology Radiation Ward, Liaoning Province Cancer Hospital and Institute (Cancer Hospital of China Medical University),
Dadong District, Shenyang, Liaoning, China
12 Department of Radiation Oncology, Zhangzhou Hospital, Teaching Hospital of Fujian Medical University, Zhangzhou, Fujian, China
13 Department of Obstetrics and Gynecology, Shengjing Hospital Affiliated to China Medical University, Shenyang, Liaoning, China
14 Department of Gynecology, Fujian Provincial Cancer Hospital, Fuzhou, China
15 Department of Radiation Oncology, Jiamusi Cancer Hospital, Jiamusi, China
16 Department of Oncology, Xiangya Hospital, Central South University, Changsha, Hunan, China
17 Department of Gynecology, The Affiliated Tumor Hospital of Harbin Medical University, Baojian Road 6, Nangang District, Harbin, China
18 Department of Radiation Oncology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China

1. Introduction agents in combination with CCRT for LACC treatment,
which merited attention and discussion. These issues
Cervical cancer, a prevalent gynecological malignant were subsequently harmonized and categorized by the
tumor, ranks as the second most common female facilitator into six items, which were presented to the panel
malignancy in China. According to the 2020 global cancer members during a virtual meeting. To achieve consensus,
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statistics analysis report, over 600,000 new cases of cervical the harmonized items were thoroughly discussed. Then,
cancer are recorded globally, with over 340,000 deaths. each board member individually formulated one or
Notably, 85% of these cases were identified in developing more statements addressing each of the six agreed-upon
countries. In China, approximately 110,000 new cases and items. In a second meeting, the panel members reviewed
60,000 deaths are recorded annually. Despite significant and further deliberated on the harmonized statements,
1-3
advances in the diagnostic accuracy and therapeutic ultimately agreeing on eight statements. The grading
efficacy of cervical cancer in recent years, 37% of patients of recommendations, assessment, development, and
are still diagnosed at locally advanced stages. 4 evaluation framework was utilized to assess the evidence
The International Federation of Gynecology and levels and recommendation grades. Levels of evidence
Obstetrics (FIGO) defines locally advanced cervical were classified as high, medium, low, and very low, whereas
cancer (LACC) narrowly as stage IB3/IIA2 and broadly recommendations were categorized as strong or weak
as stage IB3-IVA (as per the 2018 FIGO stage). LACC has (Table 1).
a propensity for distant metastasis even after undergoing
standard concurrent chemoradiotherapy (CCRT), 3. Results
resulting in a 3-year overall survival (OS) rate of only 72%. 3.1. Targeted drug combined with CCRT for LACC
This is attributed to large local tumor size and high-risk treatment
factors, such as lymph node metastasis and paravaginal 3.1.1. Combination therapy involving anti-vascular
infiltration. 5 endothelial growth factor (VEGF) antibody
In recent years, targeted drugs and immunotherapy Anti-VEGF antibodies inhibit tumor proliferation by
have significantly progressed. The LACC working group, suppressing angiogenesis and inducing endothelial cell
comprising gynecologic tumor oncologists and radiation apoptosis. Bevacizumab, a humanized immunoglobulin
oncologists, has developed a Chinese expert consensus G1 monoclonal antibody targeting VEGF, serves as the
on combining targeted and immunological drugs with primary treatment for recurrent metastatic cervical cancer
CCRT for treating LACC. This consensus aims to provide when used alongside chemotherapy. Its efficacy has also
a reliable reference and academic guidance for clinical been investigated in LACC cases. In the RTOG 0417 trial,
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practice. a Phase II study incorporating CCRT and bevacizumab for
2. Methods LACC treatment included 60 patients with sizable tumors
(n = 49 were evaluated), resulting in a 3-year OS rate of
The consensus process commenced with the application of 81.3%, a disease-free survival (DFS) rate of 68.7%, and a
the estimate-talk-estimate methodology. A multicenter locoregional lymph node failure rate of 23.2%. However,
6,7
panel comprising 20 health professionals involved in 36.7% of participants reported significant adverse effects
the diagnosis, treatment, and follow-up of LACC was (grade 3, 26.5%; grade 4, 10.2%). Given the limited
assembled. This panel included two medical oncologists, sample size of the RTOG0417 trial and the observed
15 radiation oncologists, and three gynecologists. Each clinical toxicities, caution is advised when considering
panelist independently identified the most pertinent issues bevacizumab combined with CCRT in patients with LACC
(or items) related to the use of targeted and immunological and substantial tumor burden (Table 2).

Volume 3 Issue 1 (2025) 18 doi: 10.36922/arnm.4032