Risks, benefits, and alternatives.

Sometimes women with early-stage cervical cancer aren’t great candidates for surgery. What then? This review dives into why surgery is the standard for cervical cancers IB1, IB2 and IIA1 but also into the data and how-to for alternatives using IMRT +/- concurrent chemo. First of all, all women with clinically IB-IIA cervical cancer ideally receive an upfront MRI as many may demonstrate a tumor size over 4 cm and/or parametrial invasion meaning they can jump straight to chemoradiation and avoid the toxicity of surgery followed by the inevitable recommendation for adjuvant treatment. Same goes for initial PET staging which can demonstrate otherwise occult nodal disease. Finally, a lower threshold for definitive radiation can be used for post-menopausal women as ovarian function is not on the line. | Taunk, Pract Radiat Oncol 2022