Cervical cancer: National clinical practice guidelines from the french cervical cancer guidelines group

Over the past decade, cervical cancer management has evolved substantially, with major changes in surgical approach, surgical radicality, nodal staging, imaging, radiotherapy techniques, brachytherapy and systemic treatments. To harmonize practice and integrate new evidence into clinically applicable recommendations, the French Cervical Cancer Guidelines Group developed national clinical practice guidelines for the management of patients with cervical cancer. The guideline process was conducted under the auspices of the French National College of Obstetricians and Gynecologists and involved a multidisciplinary expert panel representing the French scientific societies involved in cervical cancer care. Clinical questions were formulated using the PICO framework and addressed the full continuum of care, including initial assessment, imaging, diagnostic conization, surgical nodal staging, treatment, fertility preservation, response assessment, follow-up, recurrence and specific clinical situations. Evidence was reviewed and critically appraised according to the GRADE methodology, and all recommendations were based on the 2018 FIGO staging system. External validation was performed through a two-round Delphi process involving 87 independent reviewers. Overall, 130 PICO questions generated 158 recommendations, including 35 strong and 52 weak recommendations, while no recommendation could be issued for 71 questions. Key practice-changing recommendations include the role of diagnostic conization in early-stage assessment, avoidance of minimally invasive hysterectomy from stage IB1 disease, risk-adapted surgical radicality, sentinel lymph node biopsy with ultrastaging, image-guided brachytherapy after chemoradiotherapy, and integration of PEMBROLIZUMAB in selected locally advanced or metastatic settings.