CERVICAL CANCER IN OLDER WOMEN - A NARRATIVE REVIEW OF AGE-SPECIFIC MANAGEMENT ISSUES FROM THE FRENCH CERVICAL CANCER GUIDELINES GROUP - 29/10/26

Doi : 10.1016/j.jogoh.2026.103317

Margot Dugast ^a, Anthony Moureau ^a, Estelle Tromelin ^a, Carla Sousa ^a, Marion Mercier ^a, Xavier Carcopino ^b, Vincent Lavoué ^a,^⁎ , Xavier Carcopino ^b,^⁎, Lobna Ouldamer ², Cyrille Huchon ³, Pauline Asseeva ⁴, Henri Azaïs ⁵, Sofiane Bendifallah ⁶, Jean-Luc Brun ⁷, Geoffroy Canlorbe ⁸, Cyrus Chargari ⁹, Pauline Chauvet ¹⁰, Abel Cordoba ¹¹, Hélène Courcier ¹², Yohann Dabi ¹³, Marion de Berti ², Caroline Diguisto ², Eva Fuss ¹⁴, Thomas Gaillard ¹⁵, Tristan Gauthier ¹⁶, Witold Gertych ¹⁷, Laurence Gladieff ¹⁸, Olivier Graesslin ¹⁹, Yohan Kerbage ²⁰, Martin Koskas ¹², Enora Laas ¹⁵, Aymeline Lacorre ¹⁶, Vincent Lavoué ²¹, Lise Lecointre ¹⁴, Fabrice Lecuru ²², François Margueritte ¹⁶, Alejandra Martinez ²³, Paul-Jean Maternowski ⁷, Patrice Mathevet ²⁴, Imane Menouer ¹⁹, Camille Mimoun ³, Anthony Moureau ²¹, Antoine Netter ^b, Charles-André Philip ²⁵, Pascal Rousset ²⁶, Claire Sanson ²⁷, Isabelle Thomassin-Naggara ²⁸, Cyril Touboul ¹³, Jean Levêque ²¹

the members from the FRENCH CERVICAL CANCER GUIDELINES GROUP

^a Université de Rennes, service de gynécologie, CHU Rennes, Inserm, Irset (Institut de recherche en santé, environnement et travail) – UMRS 1085, F-35000 Rennes, France

^b Department of Obstetrics and Gynaecology, Hôpital Nord, Assistance Publique–Hôpitaux de Marseille (APHM), CEReSS, Center for Studies and Research on Health Services and Quality of Life, Aix Marseille University (AMU), Marseille, France

² Department of Gynecology, Centre Hospitalier Universitaire de Tours, INSERM U1069; Université François-Rabelais, Tours, France

³ Department of Obstetrics and Gynaecology, Lariboisière Hospital, Assistance Publique–Hôpitaux de Paris (AP-HP), Paris Cité University, Paris, France

⁴ Department of Nuclear Medicine, Hôpital Nord, Assistance Publique–Hôpitaux de Marseille (APHM), Marseille, France

⁵ Department of Gynecologic and Breast Cancer Surgery, Hôpital Européen Georges Pompidou, AP-HP, Paris Cité University, Paris, France

⁶ Department of Gynaecologic Surgery, American Hospital of Paris, Neuilly-sur-Seine, France

⁷ Department of Gynaecologic Surgery and Reproductive Medicine, Aliénor d’Aquitaine Center, Pellegrin Hospital, Bordeaux, France

⁸ Department of Gynaecologic and Breast Cancer Surgery, Pitié-Salpêtrière Hospital, Assistance Publique–Hôpitaux de Paris (AP-HP), Sorbonne University, Saint-Antoine Research Center (CRSA), INSERM UMR_S_938, Cancer Biology and Therapeutics, Paris, France

⁹ Department of Radiation Oncology, Pitié-Salpêtrière Hospital, Assistance Publique–Hôpitaux de Paris (AP-HP), Sorbonne University, Paris, France

¹⁰ Department of Obstetrics and Gynaecology, Estaing University Hospital, Clermont Auvergne University, EnCoV, Institut Pascal, CNRS UMR 6602, SIGMA Clermont, Clermont-Ferrand, France

¹¹ Department of Radiation Therapy, Centre Oscar Lambret, Lille, France

¹² Department of Obstetrics and Gynaecology, Bichat Hospital, Paris Cité University, Paris, France

¹³ Department of Obstetrics and Gynaecology and Reproductive Medicine, Tenon Hospital, Assistance Publique–Hôpitaux de Paris (AP-HP), Sorbonne University, Paris, France

¹⁴ Department of Gynaecologic Surgery, Hautepierre University Hospital, Strasbourg, France

¹⁵ Department of Gynaecologic, Breast and Reconstructive Surgery, Institut Curie, Paris, France

¹⁶ Department of Obstetrics and Gynaecology, Women, Mothers and Children Hospital (HFME), Limoges University Hospital, Limoges, France

¹⁷ Department of Gynaecologic and Oncologic Surgery, Lyon Sud Hospital, Lyon, France

¹⁸ Department of Medical Oncology, Oncopole Claudius Regaud, IUCT-Oncopole, Toulouse, France

¹⁹ Alix de Champagne Mother and Child Institute, Reims University Hospital, University of Reims Champagne-Ardenne (URCA), Reims, France

²⁰ Department of Gynaecologic Surgery, Lille University Hospital, University of Lille, INSERM U1189, OncoThAI: Laser-Assisted Therapies and Immunotherapies for Oncology, Lille, France

²¹ Department of Gynaecology, Obstetrics and Human Reproduction, CHU Anne de Bretagne, Faculty of Medicine, University of Rennes, IRSET, INSERM U1085, Rennes, France

²² Department of Breast, Gynaecologic and Reconstructive Surgery, Institut Curie, Faculty of Medicine, Paris Cité University, Paris, France

²³ Oncopole Claudius Regaud, Toulouse University Cancer Institute-Oncopole, Toulouse III–Paul Sabatier University, INSERM, CNRS, University of Toulouse, Toulouse Cancer Research Center, UMR1037, Toulouse, France

²⁴ Lausanne University Hospital (CHUV), Lausanne, Switzerland; University of Lausanne (UNIL), Lausanne, Switzerland

²⁵ Women and Children Hospital, Hospices Civils de Lyon (HCL), LabTAU INSERM U1032, Claude Bernard Lyon 1 University, Lyon, France

²⁶ Department of Medical and Interventional Imaging, Lyon Sud University Hospital, Hospices Civils de Lyon, Claude Bernard Lyon 1 University, EA CICLY, Lyon, France

²⁷ Department of Gynaecologic Surgery, Paris Saint-Joseph Hospital Group, Paris, France

²⁸ Department of Medical Imaging, Tenon Hospital, Assistance Publique–Hôpitaux de Paris (AP-HP), Sorbonne University, Paris, France

^⁎ Corresponding author: Vincent Lavoué, Service de gynécologie, CHU de Rennes, France Service de gynécologie CHU de Rennes France

Sous presse. Manuscrit accepté. Disponible en ligne depuis le Thursday 29 October 2026

ABSTRACT

Objective

To summarize the available evidence on the management of cervical cancer in older women across early and advanced disease stages, with particular attention to treatment selection, feasibility, tolerance, and specific clinical situations, including cervical cancer associated with pelvic organ prolapse.

Methods

A narrative review was conducted using PubMed/MEDLINE, Embase, and the Cochrane Library. Studies addressing surgery, radiotherapy, concurrent chemoradiotherapy, brachytherapy, para-aortic lymphadenectomy, cervical cancer associated with pelvic organ prolapse, and pre-treatment geriatric assessment were considered. The evidence was synthesized qualitatively according to six predefined clinical questions.

Results

In early-stage disease, radical hysterectomy is feasible in selected fit elderly patients but is associated with increased perioperative morbidity, with advancing age. The available evidence does not establish whether surgery or definitive radiotherapy provides superior oncological outcomes in this population. In locally advanced cervical cancer, concurrent chemoradiotherapy appears to improve survival compared with radiotherapy alone in selected older patients, but with increased toxicity. Brachytherapy is associated with improved local control and survival, yet its use decreased with advancing age. No age-specific evidence demonstrated a survival benefit form pretreatment para-aortic lymphadenectomy. Data on cervical cancer associated with pelvic organ prolapse are limited to heterogeneous case reports and small retrospective studies. Pretreatment geriatric assessment influences treatment decisions in mixed cancer populations, but cervical cancer–specific outcome data are lacking.

Conclusion

Age-specific evidence remains limited and largely retrospective, and chronological age alone should not determine access to standard treatment. Treatment selection requires integration of tumor characteristics, frailty, comorbidities, functional status, expected treatment tolerance, quality of life, and patient preferences.

Le texte complet de cet article est disponible en PDF.

Key words : cervical cancer, older women, frailty, geriatric assessment, surgery, chemoradiotherapy, radiotherapy, brachytherapy, genital prolapse