Cone biopsy and radical trachelectomy with pelvic lymph node dissection are the best treatment option for fertility preservation in early stage (IA1, IA2, IB1 and IB2) cervical cancer patients. | |
Patients not interested to maintain fertility can undergo radical hysterectomy with PLND and tailored adjuvant radiotherapy/chemoradiation and/or brachytherapy. | |
Stage IA2-IB1 cervical cancer patients are typically treated with radical hysterectomy with PLND with or without para-aortic lymph node sampling. They are further managed with adjuvant CCRT depending on the surgico-pathologic findings. Radiation therapy includes both EBRT and brachytherapy. | |
In a developing country like India, radiotherapeutic facilities are limited and generally patients have a lengthy waiting period, hence, neo-adjuvant chemotherapy with cisplatin and paclitaxel is the preferred alternative for early stage cervical cancer patients. The high cost of chemotherapeutic agents increases the economic burden on the patients. | |
For stage IB2-IVA, primary CCRT plus brachytherapy with or without adjuvant cisplatin or carboplatin based chemotherapy is an effective management option | |
Cervical cancer stage IVB is incurable and the main treatment option is palliation. Incorporation of bevacizumab with chemotherapy doublets may improve survival by a median 3.7 months. | |
Pelvic exenteration may be curative for a patient with a central, isolated recurrence but if the patient is not an exenteration candidate (eg., non-central recurrence or metastatic disease or refuses exenteration). |