Cervical cancer state-of-the-clinical-science meeting on pretreatment evaluation and prognostic factors, September 27-28, 2007: proceedings and recommendations.

OBJECTIVES We choose to review current knowledge focused on pretreatment evaluation and prognostic markers in cervical cancer and make recommendations for future research. METHODS We convened representatives from 10 of the member groups belonging to the Gynecologic Cancer Intergroup, members of the NCI's Gynecologic Cancer Steering Committee and its Cervical Cancer Task Force, investigators in the fields of imaging, translational research, gynecologic, radiation and medical oncology, patient advocates and NCI program staff for a two-day retreat. RESULTS Clinical examination must remain mandatory for staging and evaluation. Measurements of tumor volume should also be mandatory. Magnetic resonance imaging provides the most accurate imaging measure of tumor volume. Identification of lymph node (LN) metastasis needs to remain a high priority. Promising data in FDG-PET warrants multicenter validation. Validated prognostic markers include tumor volume, uterine corpus extension, cervical lymph-vascular space invasion, extent of LN metastasis, current tobacco smoking, hemoglobin levels at time of diagnosis, and HPV-16 associated cancer. No 'high-technology' biomarkers are ready for validation in multicenter trials. DISCUSSION Our current specimen collections are inadequate for discovery and validation of biomarkers. Current and future trials should mandate collection of fixed tissues as well as DNA/RNA. Effective crossgroup collaboration is necessary to permit timely completion of phase III trials. Centers with appropriate expertise and resources in the developing world should be encouraged to participate in the current clinical trial networks.