Management of locally advanced cervical cancer: Survey of practice among Thai gynecologic oncologists

Abstract

© Journal of The Medical Association of Thailand Objective: To assess current practice for the management of locally advanced cervical cancer (LACC) in Thailand. Material and Methods: Thai gynecologic oncologists who had been practicing in the field for at least one year were invited to complete an on-line self-administered questionnaire. The survey encompassed general aspect and organ-specific aspect of care including management of cervical cancer, endometrial cancer, and ovarian cancer. This study represents a part of the main study that addressed LACC management. Results: One hundred seventy gynecologic oncologists responded to the survey. Seventy-eight percent of the respondents treated the patients with bulky early-stage IB3 and IIA2 by concurrent chemoradiation, followed by neoadjuvant chemotherapy followed by radical surgery (22.4%), and surgery alone (11.8%). Almost all of respondents preferred to use concurrent cisplatin-based chemoradiation for the patients with locally advanced stage IIB to IVA. Only 1.8% of them would consider other treatment modalities. The more effective treatment modalities have been identified in order to improve outcome and reduce toxicity of standard treatment. Large disparity was observed about controversial treatment issues, including ovarian transposition, neoadjuvant chemotherapy followed by surgery, surgical staging for lymph nodes assessment, adjuvant chemotherapy after concurrent chemoradiation, and adjuvant hysterectomy. Conclusion: Most Thai gynecologic oncologists have been treating patients with LACC by mostly following standard guideline. However, there are variations in practice pattern in some controversial issues.