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Publications

Journal Article Review Ahead of print

PubMed: 42962717 DOI: 10.1016/j.jogoh.2026.103311

ASSESSMENT OF TREATMENT RESPONSE RESPONSE AND THE ROLE OF COMPLETION SURGERY AFTER CONCURRENT CRTAND BRACHYTHERAPY FOR LOCALLY ADVANCED CERVICAL CANCER - A REVIEW FROM THE FRENCH CERVICAL CANCER GUIDELINES GROUP.

J Gynecol Obstet Hum Reprod

Authors: Camille Mimoun, Xavier Carcopino, Xavier Carcopino, Lobna Ouldamer, Cyrille Huchon, Pauline Asseeva, Henri Azaïs, Sofiane Bendifallah, Jean-Luc Brun, Geoffroy Canlorbe, Cyrus Chargari, Pauline Chauvet, Abel Cordoba, Hélène Courcier, Yohann Dabi, Marion de Berti, Caroline Diguisto, Eva Fuss, Thomas Gaillard, Tristan Gauthier, Witold Gertych, Laurence Gladieff, Olivier Graesslin, Yohan Kerbage, Martin Koskas, Enora Laas, Aymeline Lacorre, Vincent Lavoué, Lise Lecointre, Fabrice Lecuru, François Margueritte, Alejandra Martinez, Paul-Jean Maternowski, Patrice Mathevet, Imane Menouer, Camille Mimoun, Anthony Moureau, Antoine Netter, Charles-André Philip, Pascal Rousset, Claire Sanson, Isabelle Thomassin-Naggara, Cyril Touboul, Jean Levêque

Affiliations

  • Department of Gynecology and Obstetrics, Lariboisière Hospital (AP-HP), 2 rue Ambroise Pare 75010, Paris, France; Paris Cité University, Paris, France.
  • Department of Obstetrics and Gynaecology, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille (APHM), CEReSS, Center for Studies and Research on Health Services and Quality of Life, Aix Marseille University (AMU), Marseille, France.
  • Department of Obstetrics and Gynaecology. Hôpital Nord, Assistance Publique-Hôpitaux de Marseille (APHM), CEReSS, Center for Studies and Research on Health Services and Quality of Life, Aix Marseille University (AMU), Marseille, France.
  • Department of Gynecology, Centre Hospitalier Universitaire de Tours, INSERM U1069; Université François-Rabelais, Tours, France.
  • Department of Obstetrics and Gynaecology, Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris Cité University, Paris, France.
  • Department of Nuclear Medicine, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille (APHM), Marseille, France.
  • Department of Gynecologic and Breast Cancer Surgery, Hôpital Européen Georges Pompidou, AP-HP, Paris Cité University, Paris, France.
  • Department of Gynaecologic Surgery, American Hospital of Paris, Neuilly-sur-Seine, France.
  • Department of Gynaecologic Surgery and Reproductive Medicine, Aliénor d'Aquitaine Center, Pellegrin Hospital, Bordeaux, France.
  • Department of Gynaecologic and Breast Cancer Surgery, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne University, Saint-Antoine Research Center (CRSA), INSERM UMR_S_938, Cancer Biology and Therapeutics, Paris, France.
  • Department of Radiation Oncology, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne University, Paris, France.
  • Department of Obstetrics and Gynaecology, Estaing University Hospital, Clermont Auvergne University, EnCoV, Institut Pascal, CNRS UMR 6602, SIGMA Clermont, Clermont-Ferrand, France.
  • Department of Radiation Therapy, Centre Oscar Lambret, Lille, France.
  • Department of Obstetrics and Gynaecology, Bichat Hospital, Paris Cité University, Paris, France.
  • Department of Obstetrics and Gynaecology and Reproductive Medicine, Tenon Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne University, Paris, France.
  • Department of Gynaecologic Surgery, Hautepierre University Hospital, Strasbourg, France.
  • Department of Gynaecologic, Breast and Reconstructive Surgery, Institut Curie, Paris, France.
  • Department of Obstetrics and Gynaecology, Women, Mothers and Children Hospital (HFME), Limoges University Hospital, Limoges, France.
  • Department of Gynaecologic and Oncologic Surgery, Lyon Sud Hospital, Lyon, France.
  • Department of Medical Oncology, Oncopole Claudius Regaud, IUCT-Oncopole, Toulouse, France.
  • Alix de Champagne Mother and Child Institute, Reims University Hospital, University of Reims Champagne-Ardenne (URCA), Reims, France.
  • Department of Gynaecologic Surgery, Lille University Hospital, University of Lille, INSERM U1189, OncoThAI: Laser-Assisted Therapies and Immunotherapies for Oncology, Lille, France.
  • Department of Gynaecology, Obstetrics and Human Reproduction, CHU Anne de Bretagne, Faculty of Medicine, University of Rennes, IRSET, INSERM U1085, Rennes, France.
  • Department of Breast, Gynaecologic and Reconstructive Surgery, Institut Curie, Faculty of Medicine, Paris Cité University, Paris, France.
  • Oncopole Claudius Regaud, Toulouse University Cancer Institute-Oncopole, Toulouse III-Paul Sabatier University, INSERM, CNRS, University of Toulouse, Toulouse Cancer Research Center, UMR1037, Toulouse, France.
  • Lausanne University Hospital (CHUV), Lausanne, Switzerland; University of Lausanne (UNIL), Lausanne, Switzerland.
  • Women and Children Hospital, Hospices Civils de Lyon (HCL), LabTAU INSERM U1032, Claude Bernard Lyon 1 University, Lyon, France.
  • Department of Medical and Interventional Imaging, Lyon Sud University Hospital, Hospices Civils de Lyon, Claude Bernard Lyon 1 University, EA CICLY, Lyon, France.
  • Department of Gynaecologic Surgery, Paris Saint-Joseph Hospital Group, Paris, France.
  • Department of Medical Imaging, Tenon Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne University, Paris, France.

Abstract

Concurrent chemoradiotherapy (CRT) followed by brachytherapy is the standard of care for locally advanced cervical cancer. However, post-treatment management remains challenging. Accurate response assessment is essential because it informs subsequent management, particularly the indication for completion surgery. Radiation-induced tissue changes may impair the reliability of clinical examination and conventional imaging, while the respective roles of advanced imaging modalities and completion surgery remain debated. Functional lumbopelvic MRI incorporating diffusion-weighted and perfusion sequences is the reference imaging modality for response assessment and provides greater diagnostic performance than clinical examination alone. FDG PET-CT offers complementary information, particularly regarding nodal disease and early metabolic response, but the routine combination of FDG PET-CT with MRI has not been shown to improve diagnostic accuracy. MRI performed early during CRT may help differentiate responders from nonresponders based on changes in the apparent diffusion coefficient. However, the optimal timing of MRI after treatment completion remains uncertain. Available evidence does not support the routine use of conization for response assessment. Completion surgery provides no prognostic benefit and increases morbidity in patients with squamous cell carcinoma who achieve a complete response after CRT and brachytherapy. Evidence remains insufficient to establish its role in adenocarcinoma. When completion surgery is indicated, delaying the procedure until at least 6-8 weeks after CRT may reduce postoperative morbidity. Simple hysterectomy should be favored over radical hysterectomy, which increases morbidity without improving survival. Current evidence demonstrates no superiority of minimally invasive surgery or laparotomy in terms of oncologic outcomes or overall morbidity.

MeSH

Hysterectomy, Uterine Cervical Neoplasms, Brachytherapy, Neoplasms, Morbidity, Therapeutics