ESTRO 37 Abstract book

S60

ESTRO 37

patient reported outcomes though the use of mobile device technology into routine clinical management, and the implementation of countermeasures to reduce unplanned hospital admissions and emergency room visits. We will also specifically discuss the use of geriatric assessments to help predict poor tolerance to therapy. The use of novel biomarkers (tumor genetics and circulating tumor DNA) pre-treatment and during treatment to improve risk-stratification and to guide treatment decisions will also be discussed. SP-0119 Personalising the management of HN cancer to minimize toxicity and maximize QOL N. Lee Memorial Sloan Kettering, New York, USA

brachytherapy without previous radical pelvic surgery is recommended in patients with unequivocally positive pelvic nodes at imaging. Debulking of suspicious nodes may be considered. Along the same line, if lymph node involvement is detected intraoperatively, further radical hysterectomy should be avoided. Patients should be referred for definitive chemoradiotherapy. In addition, nonsurgical therapy therapy can be considered when a combination of risk factors is known at diagnosis that would require an adjuvant treatment. In the above mentioned cases, pelvic lymph node dissection should be avoided. Paraaortic (at least up to the inferior mesenteric artery) lymph node dissection may be considered in patients with negative paraaortic lymph node on imaging. Minimal invasive approach is preferred for staging and surgical management. The standard lymph node staging procedure is systematic pelvic lymphadenectomy. Sentinel node biopsy before pelvic lymphadenectomy is strongly recommended. Lymph node assessment should be performed as the first step of surgical management. Intraoperative assessment of lymph node status (frozen section) is recommended. All sentinel nodes from both sides of the pelvis or any suspicious lymph nodes should be sent for frozen section. If a sentinel node is not detected, intraoperative assessment of the pelvic lymph nodes should be considered. If intraoperative lymph node assessment is negative or is not done, systematic pelvic lymph node dissection should be performed. At present, sentinel node biopsy alone cannot be recommended outside prospective clinical trials. Systematic lymph node dissection should include the removal of lymphatic tissue from regions with the most frequent occurrence of positive lymph nodes (sentinel nodes), including obturator fossa, external iliac regions, common iliac regions bilaterally, and the presacral region. Distal external iliac lymph nodes (so called circumflex iliac lymph nodes) should be spared if they are not macroscopically suspicious. The type of radical hysterectomy (extent of parametrial resection) should be based upon the presence of prognostic risk factors identified preoperatively. Major prognostic factors for oncological outcome, such as tumour size, maximum stromal invasion, and lymph vascular space invasion (LVSI), are used to categorise patients at low (size < 2cm, no LVSI, less than 1/3 stromal invasion), intermediate and high risk (size > 2m, LVSI positive, any stromal invasion) of treatment failure. A complete description of the template used for radical hysterectomy should be included in the surgical report. The 2017 modification of the Querleu-Morrow classification is recommended as a tool. Type A or B1 is recommended for low risk, type B2 or C1 for intermediate risk, type C1 or C2 for high risk. Ovarian preservation should be offered to premenopausal patients with squamous cell carcinoma and usual-type (HPV- related) adenocarcinoma. Salpingectomy should be considered. Fertility-sparing surgery (FSS) is an option is patients desiring fertility. FSS should be undertaken exclusively in gynaecological-oncological centres with comprehensive expertise in this kind of oncologic therapy. Negative pelvic lymph node status is a precondition for any FSS. The specific aim of FFS must be the resection of the invasive tumour with adequate free margins and preservation of upper part of the cervix. Intraoperative frozen section is a reliable way of assessing the upper resection margin in the trachelectomy specimen and should be considered. Radical trachelectomy (type B) should be performed for patients with cervical cancer stage T1b1 ≤ 2 cm. In more advanced cases and in lymph- node-positive cases, different propositions for fertility preservation should be discussed. The goal of the fertility preservation should be to offer the most efficient approach related to the legal aspects of the country

Abstract not received

Joint Symposium: ESTRO-ESGO: State of the art: new ESGO-ESTRO-ESP guidelines on management of cervical cancer

SP-0120 General introduction to the recommendations D. Querleu 1 1 Institut Bergonie, Surgery, BORDEAUX, France Abstract text Guidelines for the management of usual histotypes of cervical cancer were jointly elaborated by the ESGO (European Society of Gynaecologic Oncology), ESTRO, and ESP (European Society of Pathology), under the chairmanship of Professors David Cibula, Richard Pötter, and Mariarosaria Raspollini. A strict process was followed and monitored by a professional methodologist (François Planchamp, supported by a grant of the French National Cancer Institute, INCa), starting with the building of a group of 24 European experts appointed by each Society, and a systematic literature search. Recommandations were elaborated by the group at the time of two physical meetings, then submitted to a review by 159 external reviewers. Comments of the reviewers were integrated at the time of a third physical meeting of the experts group. Final recommendations are based on scientific evidence, and/or expert consensus. Staging, management of early and advanced cases, management of clinically occult cervical cancer diagnosed after simple hysterectomy, fertility-preserving treatment, cervical cancer in pregnancy, distant metastatic disease, and recurrent disease were covered. Complementary information on principles of radiotherapy and principles of pathologic evaluation has been developed. A standardized description of the templates for radical hysterectomy (2017 update of the Querleu-Morrow classification) has been adopted. Recommendations are presented at the meetings of each participating Society, published as full papers in the Journals of each society, and are freely available as web-based documents (guidelines and complete summary reports), pocket books and in the near future smartphone apps. SP-0121 Surgical approaches in stage I B cervical cancer D. Querleu 1 1 Institut Bergonie, Surgery, BORDEAUX, France Abstract text Radical surgery by an gynaecologic oncologist is the preferred treatment modality of stage IB cervical cancer with negative nodes. However, treatment strategy should aim to avoid combining radical surgery and radiotherapy due to the highest morbidity after combined treatment. For this reason, definitive radiochemotherapy and