Radiochemotherapy of cervical cancer

Abstract

Background: Locally advanced cervical cancer is a severe disease that should optimally be treated in an interdisciplinary manner. According to the joint guideline of the European societies for gynaecological oncology, radiotherapy and pathology, treatment consists of primary radiochemotherapy from stage cT1b2/T2a2 N0 or in the case of lymph node metastases. Diagnosis is made by clinical examination, biopsy and imaging. Staging is done according to FIGO (Fédération Internationale de Gynécologie et dʼObstétrique) and TNM (tumor, nodes and metastases) classifications. Methods: The aim of this article is to present the current state of the art based on the relevant literature with a special focus on the results of the EMBRACE studies. Results: Combining external beam radiotherapy with magnetic resonance imaging (MRI)-guided combined intracavitary/interstitial adaptive brachytherapy, local control rates of 92% at 5 years and overall survival rates of 67% at 10 years can be achieved, regardless of local tumour stage. The cumulative adverse event rate of grade ≥ 3 according to the Common Terminology Criteria for Adverse Events (CTCAE) is 11% after 5 years. Conclusion: Primary radiochemotherapy using modern radiotherapeutic techniques is the recommended treatment for locally advanced cervical cancer from stage T1b2 onwards. Close interdisciplinary collaboration is crucial.