2553

Protocol

(Primary treatment)
1. Stage IA1
1.1. Extrafascial total abdominal hysterectomy ( vaginal)
1.2. Brachytherapy
1.3
(Conization) Cone (Negative margins)
2. Stage IA2
2.1. Modified radical hysterectomy (type 2)
[ Lympho-vascular space involovement (LVSI)
Extrafascial hysterectomy ]
2.2. Brachytherapy + Pelvic Radiation 6-8
2.3. (Radical trachelectomy)
( 2B)
3. Stage IB1, IIA (< 4 .)
3.1. Radical hysterectomy (type 3) +
(Sampling) Para-aortic.**( 1)
3.2. Pelvic Radiation +Brachytherapy 6-8

Protocol 2553; _ 2552

Protocol 2553; _ 2552

**. Negative pelvic nodes Deep stromal invasion LVSI

(Adjuvant Radiotherapy)
. Positive pelvic nodes Positive surgical margin Positive
parametrium (Adjuvant concurrent platinum-based
chemotherapy {Protocol 1:Concurrent chemoradiation } + Radiotherapy)
. Positive Para-aortic lymph node Chest CT
- Chest CT Negative Pelvic + Para-aortic Radiation +
Brachytherapy
{ Protocol 1: Concurrent chemoradiation }
- Chest CT Positive {Protocol 3 First-line Chemotherapy for
Advanced / Recurrent cervical cancer}/
4. Stage IB2, IIA (> 4 .)
4.1. Radical hysterectomy (type 3) +
(Sampling) Para-aortic.**
4.2. Pelvic Radiation + Brachytherapy 6-8
{Protocol1}
4.3. (Neoadjuvant chemotherapy) {Protocol 2 : Neoadjuvant chemotherapy}
Radical hysterectomy (type 3) +
Para-aortic.** ( 2B)
** . Negative pelvic nodes Deep stromal invasion LVSI
(Adjuvant radiotherapy)
. Positive pelvic nodes Positive surgical margin
Positive parametrium (Adjuvant concurrent platinumbased chemotherapy{Protocol1} + Radiotherapy).
. positive Para-aortic lymph node Chest CT
- Chest CT Negative Pelvic + Para-aortic Radiation +
Protocol 2553; _ 2552

Brachytherapy {Protocol1}
- Chest CT Positive {Protocol3}/
Protocol 2553; _ 2552

5. Stage IIB, IIIA, IIIB

Pelvic Radiation + Brachytherapy 6-8
{Protocol 1: Concurrent chemoradiation } + Para-aortic Radiation
6. Stage IVA
6.1. Pelvic Radiation + Brachytherapy 6-8
{Protocol 1: Concurrent chemoradiation }
6.2 Pelvic exenteration Vesico-vaginal
Recto-vaginal fistula
7. Stage IVB
7.1. {Protocol 3} /
7.2. Palliative (, Supportive & Symptomatic,
).
(Recurrence treatment)
1. Local recurrence Radical surgery
1.1 () {Protocol1}
[Central recurrence (< 2 .)
Brachytherapy]
1.2 Pelvic exenteration ( fistula)
(Pelvic sidewall) ( 2B)
2. Local recurrence
2.1 Pelvic exenteration
( 2B)
2.2 () Protocol 3
Protocol 4
3. Recurrent metastatic cancer
Protocol 2553; _ 2552

 () Protocol 3
Protocol 4
Palliative Radiation Therapy
Stage IVB Unresectable recurrent cancer
, , ,
,


External beam radiotherapy Brachytherapy

1 Palliative radiotherapy for unresectable primary tumor

2 Palliative radiotherapy for distant metastatic sites such as bone, brain, spine, lymph nodes, soft
tissue and others
........................................................................

Protocol 2553; _ 2552

Protocol 2553; _ 2552