Radiation Therapy in Cervical Cancer

Cervical cancer is the fourth most frequent cancer and the fourth leading cause of cancer death in women with considerable geographical variation depending on the accessibility to regular screening and vaccination. It is most frequently diagnosed between the age of 40 and 59 years. Cervical cancer management depends on the Fédération Internationale de Gynécologie et d‘Obstétrique (FIGO) stage at diagnosis and histopathological risk factors. A fertility sparing approach may be considered in women with early stage cervical cancer (FIGO stage ≤ IB1). Modified radical hysterectomy with pelvic lymphonodectomy is recommended in patients with tumor ≤ FIGO stage IIA1 and selected IIA2 where need for adjuvant therapy is not expected. Women with positive margins, positive lymph nodes, and parametrial infiltration in histopathological examination should receive postoperative chemoradiation. Adjuvant radiation therapy (RT) should be considered in patients with a combination of intermediate risk factors. In women with locally more advanced tumors (FIGO stage ≥ IIB and extensive IIA2) and in those who are medically inoperable, definitive RT including brachytherapy ± concurrent platin-based (cisplatin preferred) chemotherapy depending on the risk factors is the treatment of choice. Image-guided RT with intensity-modulated RT and magnetic resonance imaging- (MRI) based brachytherapy can significantly improve the quality-of-life women receiving definitive RT. Regular follow-up with gynecological examination and imaging is crucial for early detection of tumor relapse and appropriate treatment.