Recidiva ou progressão do câncer cervical após quimioradiação definitiva: local em campo...

Visão determinística da entidade fonte YAML. A autoridade clínica permanece com os IDs de fonte citados e estado de assinatura do revisor.

ID	`RF-CERVICAL-TRANSFORMATION-PROGRESSION`
Tipo	Sinal de alerta
Estado	reviewed 2026-04-27 \| pending_clinical_signoff
Doenças	`DIS-CERVICAL`
Fontes	`SRC-ESMO-CERVICAL-2024` `SRC-NCCN-CERVICAL-2025`

Origem da bandeira vermelha

Definição	Cervical cancer recurrence or progression after definitive chemoradiation: in-field local recurrence (consider pelvic exenteration), distant metastatic recurrence, or persistent disease at first post-CRT imaging (3-month PET-CT). Routes from curative-intent CRT to systemic-therapy algorithm (platinum + paclitaxel + bevacizumab ± pembrolizumab).
Direcção clínica	intensificar
Categoria	transformação-progressão

Lógica de Desencadeamento

{
  "any_of": [
    {
      "finding": "cervical_post_crt_recurrence",
      "value": true
    },
    {
      "finding": "cervical_post_crt_persistent_disease",
      "value": true
    },
    {
      "finding": "metastatic_progression",
      "value": true
    },
    {
      "finding": "pet_residual_disease_3mo",
      "value": true
    }
  ],
  "type": "composite_clinical"
}

Notas

Cervical recurrence is etiologically distinct from indolent-lymphoma transformation — this RF flags transition from curative-locoregional to palliative-systemic intent. In-field locoregional recurrence in previously-irradiated pelvis: pelvic exenteration is the only curative-intent salvage for select fit patients (5y OS ~30-50% in carefully-selected). Distant metastatic recurrence: KEYNOTE-826 regimen if PD-L1 CPS ≥1 and chemo-naive in metastatic setting; tisotumab vedotin (innovaTV 301 — Vergote NEJM 2024) for platinum-refractory 2L+. shifts_algorithm empty — recurrence routes to a separate algorithm not yet authored (ALGO-CERVICAL-RECURRENT-2L, planned).

Usado por

Não há referências reversas encontradas no corpus YAML.