IMR Press / EJGO / Volume 24 / Issue 5 / pii/2003182

European Journal of Gynaecological Oncology (EJGO) is published by IMR Press from Volume 40 Issue 1 (2019). Previous articles were published by another publisher on a subscription basis, and they are hosted by IMR Press on imrpress.com as a courtesy and upon agreement with S.O.G.

Open Access Original Research

Development of an evidence-based algorithm for the management of cervical cancer

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1 Department of Public Health Medicine, The Guy' s, King' s College and St Thomas' Hospitals Schools of Medicine Dentistry and Biomedical Sciences, London, UK
2 Department of Gynaecological Oncology Guy' s and St Thomas' Hospital, London, UK
Eur. J. Gynaecol. Oncol. 2003, 24(5), 365–372;
Published: 10 October 2003
Abstract

Objective: To develop a description of the management of cervical cancer to support locally developed, regional guidelines and to identify the level of primary research evidence to support it. Design: Development of a flow-charted algorithm, using regional guidelines and clinician consensus. A Medline literature search for primary research was done to validate the algorithm and selection of papers, to verify if they were valid according to pre-defined criteria and to compare algorithm management with an alternative. Main Outcome Measure: The highest level of evidence for algorithm management was based on the design of the supporting research. Results: Twenty percent of the algorithm is supported by level I evidence (randomised controlled trials), 70% by level II evidence (cohort studies) and 10% by level IV evidence (expert opinion or case series). Level II evidence supports the management of Stage Ia, squamous cell carcinoma by cone biopsy or a simple hysterectomy. This level of evidence also applies to research on the management of Stages lb-IIa, by radical hysterectomy and pelvic lymphadenec­tomy followed by radiotherapy, if the lymph nodes are positive. Radiotherapy to treat Stages IIb-IV cervical cancer is supported by level I evidence. The management of Stage I adenocarcinoma is supported by level II evidence. Conclusions: Evaluations of the effect of informing clinicians of the strengths of the proposed management are now required, as constructing evidence-based algorithms is worthwhile, only if they are likely to affect clinical practice.

Keywords
Cervical cancer
Clinical algorithm
Evidence-based medicine
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