FIGO Stage IIB Cervical Cancer Treatment
Standard Curative Treatment
Concurrent chemoradiation with weekly cisplatin 40 mg/m² plus external-beam radiotherapy and brachytherapy is the definitive standard of care for FIGO stage IIB cervical cancer, achieving a 30–50% reduction in risk of death compared with radiation alone. 1, 2
Radiation Therapy Components
- External-beam radiotherapy should deliver 40–60 Gy in 20–30 fractions to the whole pelvis, covering the primary tumor, parametrial tissue, and at-risk pelvic lymph nodes 2
- For disease with distal parametrial invasion or pelvic nodal metastasis, escalate the pelvic dose to a minimum of 55 Gy, with optional boost to limited volumes up to 65–70 Gy 2
- Brachytherapy is an essential component and must be included to achieve the target total dose of 80–90 Gy to the tumor 2, 3
- Complete the entire course (external beam plus brachytherapy) within 8 weeks—treatment duration exceeding 8 weeks significantly worsens outcomes 2
Concurrent Chemotherapy Regimen
- Administer cisplatin 40 mg/m² intravenously weekly during the external-beam radiation phase 1, 2, 3
- This regimen provides an absolute 8% improvement in 5-year overall survival, 9% improvement in locoregional disease-free survival, and 7% improvement in metastasis-free survival 3
- Chemotherapy is typically given only during external-beam radiation, not during brachytherapy 1
Alternatives When Cisplatin Is Contraindicated
If cisplatin cannot be used due to renal impairment, neuropathy, or other contraindications, carboplatin is the preferred alternative. 1, 2, 3
- Administer carboplatin AUC-based dosing (commonly 133 mg/m² weekly for six weeks) concurrently with external-beam radiotherapy 2
- Non-platinum concurrent chemoradiation regimens may be considered for patients unable to receive any platinum agent, though evidence is weaker 1, 3
Follow-Up Schedule
- First 2 years: Clinical and gynecological examination every 3 months, including cervical cytology (accounting for radiation-induced changes) 3
- Years 3–5: Clinical and gynecological examination every 6 months 3
- After 5 years: Annual clinical and gynecological examination 3
- SCC antigen monitoring can be useful for squamous cell carcinomas if initially elevated 2, 3
Imaging for Treatment Planning
- MRI is superior to CT for assessing tumor extension in the pelvis and abdomen and should be used for treatment planning 2
- Chest CT is optional to evaluate for thoracic metastases 2
- PET is useful for nodal assessment but remains under evaluation 2
Common Pitfalls to Avoid
- Do not use surgery as primary treatment for stage IIB disease—an Italian randomized trial showed identical survival outcomes for radiation versus surgery (with or without postoperative radiation), but combined modality approaches had significantly higher complication rates 1
- Do not exceed 8 weeks total treatment time—prolonged duration is associated with worse local control and survival 2
- Do not omit brachytherapy—it is essential for delivering the high central dose required for tumor control 2, 3
- Avoid cisplatin plus 5-FU combinations when single-agent cisplatin is equally effective and less toxic 1
Toxicity Considerations
- Concurrent chemoradiation increases acute gastrointestinal and hematological toxicity compared with radiation alone 3
- Long-term side effects are generally manageable, with no significant increase in severe rectal complications 2
- Single-agent cisplatin produces lower toxicity than cisplatin plus 5-FU regimens 1
Emerging Evidence (Not Yet Standard)
- Adjuvant chemotherapy with cisplatin-gemcitabine after concurrent chemoradiation has shown improved progression-free and overall survival in stages IIB–IV in one study, but this remains Level II-C evidence and should be confined to clinical trials 3
- Neoadjuvant chemotherapy followed by radical surgery is under investigation in ongoing trials but is not currently recommended as standard treatment for stage IIB disease 4, 5