NCCN临床实践指南：宫颈癌（2024.V1）更新内容.docx

NCCN临床实践指南：宫颈癌（2024.V1）更新内容NCCN临床实践指南：宫颈癌（2024.V1）对上版内容进行了更新,为了方便广大妇产科同道比对，将更新部分整理如下:TaokiaikaUbomboiNCCNGuidelineVr*k>n1.2024C4rklCancerNational Comprehensive Cancer Network,NCCN GuideIinesVersion 1.2024 Cervical CancerNCCN GUidehneS MdeXTabte ” ContentSDisCUSSknFOOTNOTESFORCERY3cPrineipteSOfImaging(CERV>>gQ%*Gdal5益正J4lr>calStaQina(CER3C).t(XCisthePreierredmethodofdiagnosticexcBx.butLEEPisacceptable.providedadequatemarginsandproperonetatcnareobtained.ECCabovetheexsishouldbeadded.exoefXinpregnancyERadiatIOncanbeanoptionforpatentsaremedcalyInoperabtecpriesOfRadiaIiOHTgaoV(CERAD).0Forpatientswhoare-higherrtsk.suchasthosex>areIA2withLVSi.Considerattoncanbegen10addingconcentplathum-containingchemotherapywithexternalbeamRT(EBRT)33ngcisplatinasashg*eagent(<xcaopiatinICiSaamkMoteranQ.(SeeSyslcmicThefaPVforCefViGaiCanOefCERV4r).CERV-2AIAl期（无LVSl）、IA2>IB1期（无LVSI）、IA1-IA2期（伴LVSI）JB1期和选择性IB2期（保留生育功能ICERV-2）的脚注。脚注h修订：没有数据支持保留生育功能的手术可以用于小细胞神经内分泌肿瘤、胃型腺癌。（删掉了恶性腺癌”这一类型）:脚注j修订：CKC是首选的诊断性切除方法，但如果获得足够的边缘和适当开口方向，LEEP也可以选择。除妊娠期外，应加做锥顶上方的ECC（也适用于CERV-3A）o-（明确了除妊娠期外均应进行ECC,而不是简单提出根据临床指征行ECC）National Comprehensive Cancer Network"NCCN GuideIinesVersion 1.2024 Cervical CancerCONICAL STAGEcBIOPSY RESULTSIttve margins medically 9 tableNogattvo margins and medically operableObserveExtrafasclai hystoroctcMnySurvoiIUnce iCERV-11)Positive margins for dysplasia or carcinoma and medically inoperablePositive margins for dysplasia or c ar ci no ma.and medically operableStage IA2-4B1 cervical carcinoma (Based on cone biopsy and ail conservative surgery criteria must be met): No LVSI Negative cone margins Squamous cell (any grade) or usual type adenocarcinoma (grade 1 or 2 onty) Tumor size <2 cm Depth of invasion 510 mm Negative imaging for metastatic diseaseBrachytherapyn ± PeMC EBRTn Consider repeat cone biopsy to be<ter evaluate depth of Invasion to rule out stage IA21 disease orExtrafasclai (If margin positive for dysplasia) or modified radical hysterectomy pelvic Iyfnphadenectomy if margins positive for CarCInOfnag (category 2B for node dissection) (consider SLN mapping)。I Extrafasciai hystoroctcxny POMC Iymphadonoctomy9I(OrSLNmapping)Stage IA1-4A2 WithLVSI.Modified radical hysterectomy pelvic Iymphadenectomy9 (consider SLN mapping)。 orPelvic EBRTfn n o brachytherapynMot* AJl rcOmmendAttcm « CWgory 2A - otf*m* incMtACMeaI Trtate: NCCM better. 0wt Z bMt OMno< n pMtoM Wcch tein CftnkJi 2. PlBWAttoft in dinted IftelB to ncourKSurgIcaIFIndIngs (CERVS>Surgical Findings 【CERVgSurgicaIFindings(CERV-J)Surveilance (CEBSfdJUCERVCERV-3IAl期(无LVSl)、IA2-IB1期(无LVSl)、IA1-IA2期（伴LVSI）（不保留生育功能）1A1期无LVSI,根据锥体活检结果分类路径的更改：。在根据锥体活检结果判断是否可行手术时，强调为医学原因可行或不可行手术。增加了一个新的锥体活检结果分类路径：切缘存在非典型增生或癌且不能手术者。CERV-3ACERV-3的脚注脚注m修订：对于因医学原因不能手术的患者，放疗也是一种选择（也适用于CERV-4）o。脚注。修订：对于高风险患者，如IA2期合并LVSI者，可考虑EBRT联合同步含钳化疗，使用顺钳作为单一药物（或卡钳，如果顺柏不耐受）。（见宫颈癌的全身治疗CERV-F）（增加了蓝字内容）National Comprehensive Cancer Network*NCCN Guidelines Version 1.2024 Cervical CancerNCCN G*nes IndeK Tafate Of CorUnts DttCsoCUNICAL STAGEcStage 旧 1 not moeting con*orvattv surgry Crlteria Stage B2 SUge MlPRIMARY TREATMENT (NON.FERTILITY SPARING)Radical hysterectomy pelvic IymphadenectomyO (category 1)_± pvaaoctic Iyfnphadonectomy (category 2B) (contkfor SLN mapping)orPeMc EBRTn n Ixachytherapyn t concurrent plattn urn-containing Chemother apyp ISurgical FhKNnS (CERV0Surveillance tCERJjStog9 B3 and Stage IIA2(also CERV-6 for additional recommendations for non-pdfnaryBurgery patients)PeMc EBRTn concurrent piatinumcontaining Chemotherapyp brae hythorapyn (category 1)Surveillance (CERVdI)Radical hysterectomy pelvic tymphadenectomyO± paraortic Iymphadenectomy (category 2B) OfPelvic EBRTn concurrent ptotinumcotaining Chomothorapyp Ixachytlwrapyn so¼ctlvo completion hystericKxn>(category 蜀Surgical Findings (CERV-SurveiIlance(CERVll)E RMlaQOn CangBn CPeOn tor pdtwnu who m rwcally inoperable"Ptindam Of RAdiattofi ThgfaOy (CERVDi° Coocunent Piaknunxoniaining ce<no<e<ay Wtth EBRT uKAm dsp<atf) as a w19te agent (or cart>o0Bbn if dWbn 列OtefanO (See Syler: IhecapyG-ncuUC让<、“山一 一 一 .一Q m approach ShOUd or*y be csde<ed in the p<lenb WhMe IUmOf shows a poor reponte i evidre o< reMM dteease "er Chemofadiabon ra9eukM txacMirapy (GB Or G pMt> forw4om K3BT 6 not attbteCERVdCERV-4 IB1, IB2、IB3和IIA1、A2期（不保留生育功能）。整个指南中脚注P修订：EBRT联合同步含粕化疗，使用顺粕 作为单一药物（或卡粕，如果顺粕不耐受）。（见宫颈癌的全身 治疗CERV-F ）-（增加了蓝字内容）。脚注q修订：这种方法只能考虑用于放化疗后+影像引导近距 离放射治疗（IGBT）后肿瘤反应差且证据表明有残留病灶的患者 或IGBT不可行的患者。（替换了因既往适用于肿瘤范围广、EBRT有效、子宫解剖结构式近距离放疗无法充分覆盖病灶的患者）NCCNNationalCompfobensiveCarcrNetwork-IMAOINGKtSULTSPRIMARYTRtATMKNTPfMc EBRFPoH adnoply Oy CT. MM. an3 FDGPETJCT (RGO 201S St>9Cr)<P»Mc MoDlalint