A current perspective on adjuvant radiation therapy for early-stage cervical cancer

The most important treatment modality, and thus the treatment of choice, for early-stage cervical cancer (CC) is radical surgery. Based on the subsequent pathological findings, early-stage CCs are classified as low risk (LR), intermediate risk (IR), or high risk (HR). Adjuvant therapy is guided by assignment to one of the above-mentioned risk groups. Adjuvant therapy is not indicated for LR stages. The indication for adjuvant radiotherapy (RT) in patients with IR early-stage CC is based on the presence of the so-called Sedlis criteria from a single prospective randomised study published as early as 1999. With improvements in pre-operative diagnosis and surgical techniques, efforts are underway to de-escalate adjuvant therapy in an attempt to minimise overall treatment related morbidity. The indication for adjuvant RT in IR early-stage CC is therefore not based on a phase 3 randomised trial in the context of current diagnostic and therapeutic practices. For the time being, a shared treatment decision-making approach should be employed. The same essentially applies to the inclusion of adjuvant vaginal brachytherapy (VBT) in the treatment regimen. In this case, only a limited number of retrospective studies are available. In cases where vaginal resection margins are positive or close to the margin, it is generally recommended.