ASSESSMENT OF TREATMENT RESPONSE RESPONSE AND THE ROLE OF COMPLETION SURGERY AFTER CONCURRENT CRTAND BRACHYTHERAPY FOR LOCALLY ADVANCED CERVICAL CANCER - A REVIEW FROM THE FRENCH CERVICAL CANCER GUIDELINES GROUP
Abstract
Concurrent chemoradiotherapy (CRT) followed by brachytherapy is the standard of care for locally advanced cervical cancer. However, post-treatment management remains challenging. Accurate response assessment is essential because it informs subsequent management, particularly the indication for completion surgery. Radiation-induced tissue changes may impair the reliability of clinical examination and conventional imaging, while the respective roles of advanced imaging modalities and completion surgery remain debated. Functional lumbopelvic MRI incorporating diffusion-weighted and perfusion sequences is the reference imaging modality for response assessment and provides greater diagnostic performance than clinical examination alone. FDG PET-CT offers complementary information, particularly regarding nodal disease and early metabolic response, but the routine combination of FDG PET-CT with MRI has not been shown to improve diagnostic accuracy. MRI performed early during CRT may help differentiate responders from nonresponders based on changes in the apparent diffusion coefficient. However, the optimal timing of MRI after treatment completion remains uncertain. Available evidence does not support the routine use of conization for response assessment. Completion surgery provides no prognostic benefit and increases morbidity in patients with squamous cell carcinoma who achieve a complete response after CRT and brachytherapy. Evidence remains insufficient to establish its role in adenocarcinoma. When completion surgery is indicated, delaying the procedure until at least 6-8 weeks after CRT may reduce postoperative morbidity. Simple hysterectomy should be favored over radical hysterectomy, which increases morbidity without improving survival. Current evidence demonstrates no superiority of minimally invasive surgery or laparotomy in terms of oncologic outcomes or overall morbidity.
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BibTeX
@article{mimoun2026assessment,
title = {{ASSESSMENT OF TREATMENT RESPONSE RESPONSE AND THE ROLE OF COMPLETION SURGERY AFTER CONCURRENT CRTAND BRACHYTHERAPY FOR LOCALLY ADVANCED CERVICAL CANCER - A REVIEW FROM THE FRENCH CERVICAL CANCER GUIDELINES GROUP}},
author = {Camille Mimoun and Xavier Carcopino and Lobna Ouldamer and Cyrille Huchon and Pauline Asseeva and Henri Azaïs and Sofiane Bendifallah and Jean-Luc Brun and Geoffroy Canlorbe and Cyrus Chargari and Pauline Chauvet and Abel Cordoba and Hélène Courcier and Yohann Dabi and Marion de Berti and Caroline Diguisto and Eva Fuss and Thomas Gaillard and Tristan Gauthier and Witold Gertych and Laurence Gladieff and Olivier Graesslin and Yohan Kerbage and Martin Koskas and Enora Laas and Aymeline Lacorre and Vincent Lavoué and Lise Lecointre and Fabrice Lecuru and François Margueritte and Alejandra Martinez and Paul-Jean Maternowski and Patrice Mathevet and Imane Menouer and Camille Mimoun and A Moureau and Antoine Netter and Charles-André Philip and Pascal Rousset and Claire Sanson and Isabelle Thomassin-Naggara and Cyril Touboul and Jean Levêque},
journal = {Journal of Gynecology Obstetrics and Human Reproduction},
year = {2026},
month = nov,
doi = {10.1016/j.jogoh.2026.103311},
url = {https://hal.science/hal-05850542v1},
note = {CC BY},
}
RIS
TY - JOUR
TI - ASSESSMENT OF TREATMENT RESPONSE RESPONSE AND THE ROLE OF COMPLETION SURGERY AFTER CONCURRENT CRTAND BRACHYTHERAPY FOR LOCALLY ADVANCED CERVICAL CANCER - A REVIEW FROM THE FRENCH CERVICAL CANCER GUIDELINES GROUP
AU - Camille Mimoun
AU - Xavier Carcopino
AU - Lobna Ouldamer
AU - Cyrille Huchon
AU - Pauline Asseeva
AU - Henri Azaïs
AU - Sofiane Bendifallah
AU - Jean-Luc Brun
AU - Geoffroy Canlorbe
AU - Cyrus Chargari
AU - Pauline Chauvet
AU - Abel Cordoba
AU - Hélène Courcier
AU - Yohann Dabi
AU - Marion de Berti
AU - Caroline Diguisto
AU - Eva Fuss
AU - Thomas Gaillard
AU - Tristan Gauthier
AU - Witold Gertych
AU - Laurence Gladieff
AU - Olivier Graesslin
AU - Yohan Kerbage
AU - Martin Koskas
AU - Enora Laas
AU - Aymeline Lacorre
AU - Vincent Lavoué
AU - Lise Lecointre
AU - Fabrice Lecuru
AU - François Margueritte
AU - Alejandra Martinez
AU - Paul-Jean Maternowski
AU - Patrice Mathevet
AU - Imane Menouer
AU - Camille Mimoun
AU - A Moureau
AU - Antoine Netter
AU - Charles-André Philip
AU - Pascal Rousset
AU - Claire Sanson
AU - Isabelle Thomassin-Naggara
AU - Cyril Touboul
AU - Jean Levêque
PY - 2026
DA - 2026/11/03
JO - Journal of Gynecology Obstetrics and Human Reproduction
DO - 10.1016/j.jogoh.2026.103311
UR - https://hal.science/hal-05850542v1
AB - Concurrent chemoradiotherapy (CRT) followed by brachytherapy is the standard of care for locally advanced cervical cancer. However, post-treatment management remains challenging. Accurate response assessment is essential because it informs subsequent management, particularly the indication for completion surgery. Radiation-induced tissue changes may impair the reliability of clinical examination and conventional imaging, while the respective roles of advanced imaging modalities and completion surgery remain debated. Functional lumbopelvic MRI incorporating diffusion-weighted and perfusion sequences is the reference imaging modality for response assessment and provides greater diagnostic performance than clinical examination alone. FDG PET-CT offers complementary information, particularly regarding nodal disease and early metabolic response, but the routine combination of FDG PET-CT with MRI has not been shown to improve diagnostic accuracy. MRI performed early during CRT may help differentiate responders from nonresponders based on changes in the apparent diffusion coefficient. However, the optimal timing of MRI after treatment completion remains uncertain. Available evidence does not support the routine use of conization for response assessment. Completion surgery provides no prognostic benefit and increases morbidity in patients with squamous cell carcinoma who achieve a complete response after CRT and brachytherapy. Evidence remains insufficient to establish its role in adenocarcinoma. When completion surgery is indicated, delaying the procedure until at least 6-8 weeks after CRT may reduce postoperative morbidity. Simple hysterectomy should be favored over radical hysterectomy, which increases morbidity without improving survival. Current evidence demonstrates no superiority of minimally invasive surgery or laparotomy in terms of oncologic outcomes or overall morbidity.
SN - 2468-8495
SN - 2468-7847
ER -