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Table 3 Summary of Cervical Cancer Management Practices Followed in India

From: Meeting report, “First Indian national conference on cervical cancer management - expert recommendations and identification of barriers to implementation”

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).
  1. Legend: PLND Pelvic lymph node dissection, CCRT Concurrent chemoradiation therapy, EBRT External beam radiation therapy