Postoperative adjuvant radiation for cervix cancer: reflections on the evidence and a peep into the future

Early stage cervical cancer, stages IB1-2 and IIA1, can be treated with (chemo)radiation and brachytherapy or radical hysterectomy with or without further adjuvant (chemo)radiation. In a carefully selected cohort for surgery, traditionally a small proportion of patients would need adjuvant (chemo)radiation so that the therapeutic ratio is maximized. However, advances in radiation technology, specifically intensity modulated radiotherapy, have led to a reduction in treatment related adverse events. Also, recent developments in risk stratification suggest using a lower threshold to offer adjuvant treatment to minimize pelvic relapse. These developments together present opportunities of not only re-examining the therapeutic ratio but also of further evolving postoperative risk stratification. This review article summarizes the current evidence on adjuvant treatment strategies and summarizes the key areas where research should be focused.

Automated summary

This article reviews the treatment strategies for early stage cervical cancer and highlights the latest advances in radiation technology and risk stratification research. These developments not only reduce treatment-related adverse events but also provide opportunities to re-evaluate the therapeutic ratio and further develop postoperative risk stratification.