From the Guidelines
In advanced cervical cancer, hysterectomy is not typically performed after chemoradiation therapy (CRT) due to increased morbidity and no overall survival benefit, as supported by recent guidelines and studies 1. The treatment approach for advanced cervical cancer depends on the cancer stage and individual patient factors. For locally advanced cervical cancer, the standard treatment typically begins with concurrent chemoradiation therapy, which combines external beam radiation with chemotherapy. Some key points to consider in the treatment of advanced cervical cancer include:
- Concurrent chemoradiation therapy is the treatment of choice for stages IB2, II, III, and IVA disease, based on the results of randomized clinical trials 1.
- The use of concurrent chemoradiation results in a 30% to 50% decrease in the risk of death compared with RT alone 1.
- Adjuvant hysterectomy after RT has been shown to improve pelvic control, but not overall survival, and is associated with increased morbidity 1.
- A recent Cochrane review found insufficient data to demonstrate a survival benefit associated with surgery in women with locally advanced cervical cancer 1.
- The morbidity associated with completion surgery may be reduced using a laparoscopic technique 1. However, in some cases, adjuvant hysterectomy may be considered in patients whose extent of disease or uterine anatomy precludes adequate coverage by brachytherapy 1.
From the Research
Treatment Options for Advanced Cervical Cancer
- In advanced cervical cancer, treatment options may include a combination of therapies such as chemotherapy, radiation therapy, and surgery 2, 3, 4.
- The standard treatment for locally advanced cervical cancer typically involves chemoradiotherapy, which includes concurrent cisplatin-based chemotherapy and radiation therapy, followed by intracavitary brachytherapy 5.
- Hysterectomy, which is the surgical removal of the uterus, may be considered as an additional treatment option in some cases, particularly for patients with residual disease after chemoradiotherapy 6.
Role of Hysterectomy in Advanced Cervical Cancer
- Studies have investigated the role of hysterectomy in addition to radiotherapy or chemotherapy, or both, in the treatment of locally advanced cervical cancer 4.
- The evidence suggests that hysterectomy may improve survival outcomes in patients with residual disease after chemoradiotherapy, but the overall benefit of adding hysterectomy to standard treatment is still unclear 4, 6.
- Adjuvant hysterectomy after radiochemotherapy has been shown to have a low complication rate and may improve progression-free and disease-specific overall survival in patients with residual tumor 6.
Chemotherapy and Radiation Therapy
- Chemotherapy and radiation therapy are the mainstays of treatment for advanced cervical cancer, with cisplatin-based regimens being the most commonly used 2, 5.
- The combination of chemotherapy and radiation therapy has been shown to improve survival outcomes and reduce the risk of recurrence in patients with locally advanced cervical cancer 2, 3.
- Intensification of systemic chemotherapy, such as using multiple agents or higher doses, is being investigated as a way to further improve treatment outcomes, but requires careful evaluation to minimize toxicity 5.