Management of Locally Advanced Cervical Cancer: Survey of Practice among Thai Gynecologic Oncologists
Rittiluechai K, MD1, Sermsukcharoenchai N, MD1, Thiangtham K, MD1, Chanpanitkitchot S, MD2, Hanprasertpong J, MD3, Charoenkwan K, MD, MSc4, Thai Gynecologic Cancer Society (TGCS)5
Affiliation : 1 Gynecologic Oncology Division, Department of Obstetrics and Gynecology, Phramongkutklao Hospital, Bangkok, Thailand 2 Department of Obstetrics and Gynecology, Rajavithi Hospital, College of Medicine, Rangsit University, Bangkok, Thailand 3 Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand 4 Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand 5 Office of the Thai Gynecologic Cancer Society, Bangkok, 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.
Keywords : Cervical cancer, Gynecologic oncologist, Practice pattern
