Patients with locally advanced cervical cancer (LACC) are treated according to a well-defined strategy relying on concurrent chemoradiation (CCRT) with weekly CISplatin 40 mg/m2, followed by a sequential intracavitary brachytherapy boоst. This strategy lowers the risk of cancer-related death by 30 to 50%. The overall treatment timing is also crucial for the treatment's efficacy, with retrospective clinical evidence noting that the overall treatment timing, between the first radiotherapy session and the brachytherapy completion, should be ideally less than 51–52 days to maximize local control. Despite the proven effectiveness of treatment, the mortality associated with LACC remains high.
The aim of the present overview is to review the available evidence supporting the use of combined chemoradiation in patients with LACC.
The published trials and meta-analyses confirmed the established notion that CCRT outweighs radiotherapy (RT) alone, offering an absolute survival benefit of 6–8%, despite the fact that the benefit of chemoradiotherapy (CRT) on overall survival (OS) decreased with increasing disease stage. An analogous improvement was also seen in disease-free survival and the locoregional or distant recurrence rate. CCRT with weekly cisplatin has been established as the standard of care for LACC. CCRT with cisplatin-based doublets significantly improved therapeutic outcomes over monotherapy but resulted in increased toxicity. For this reason, this concept is not adopted in daily practice. These results support the use of CRT in LACC instead of RT alone.
In order to improve long-term control, further studies are needed to explore the role of adjuvant and neo-adjuvant chemotherapy in the comprehensive treatment of LACC. The assessment of OS, toxicity, and quality of life will be paramount in determining the optimal definitive treatment regimen.
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