Current Standards in the Management of Early and Locally Advanced Cervical Cancer: Update on the Benefit of Neoadjuvant/Adjuvant Strategies

Abstract

Globally, cervical cancers continue to be one of the leading causes of cancer-related deaths. The primary treatment of patients with early-stage disease includes surgery or radiation therapy with or without chemotherapy. The main challenge in treating these patients is to maintain a curative approach and limit treatment-related morbidity. Traditionally, inoperable patients are treated with radiation therapy solely and operable patients undergo upfront surgery followed by adjuvant (chemo) radiotherapy in cases with poor histopathological prognostic features. Patients with locally advanced cervical cancers are treated with concurrent chemoradiotherapy followed by an image-guided brachytherapy boost. In these patients, the main pattern of failure is distant relapse, encouraging intensification of systemic treatments to improve disease control. Ongoing trials are evaluating immunotherapy in locally advanced tumours following its encouraging efficacy reported in the recurrent and metastatic settings. In this article, clinical evidence of neoadjuvant and adjuvant treatments in cervical cancer patients is reviewed, with a focus on potential strategies to improve patients' outcome and minimize treatment-related morbidity.

Keywords: brachytherapy; cervical cancer; chemotherapy; immunotherapy; radiation oncology.

Figure 1

Treatment algorithm for cervical cancers according to FIGO 2018 classification [22,24,26,27,28,29,31,32,43,44,45,52,53,54,55,56,57,58,60,61,62,63,64,65,67,68,69,70,71,72,91]. FIGO, Féderation Internationale de Gynécologie et d’Obstétrique; PLND, pelvic lymph node dissection; SLN, sentinel lymph node; LN, lymph node; CCRT, concurrent chemoradiotherapy; RT, radiotherapy; BT, brachytheraph; LVSI, lymphovascular space invasion; DSI, Deep stromal invasion.