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Review

Current Standards in the Management of Early and Locally Advanced Cervical Cancer: Update on the Benefit of Neoadjuvant/Adjuvant Strategies

1
Department of Radiation Oncology, Centre Hospitalier Universitaire, 80000 Amiens-Picardie, France
2
Department of Medical Oncology, Gustave Roussy Comprehensive Cancer Centre, 94800 Villejuif, France
3
Department of Radiation Oncology, Gustave Roussy Comprehensive Cancer Centre, 94800 Villejuif, France
4
Department of Pathology, Gustave Roussy Comprehensive Cancer Center, 94800 Villejuif, France
5
Department of Surgery, Gustave Roussy Comprehensive Cancer Center, 94800 Villejuif, France
*
Author to whom correspondence should be addressed.
Academic Editor: David G. Mutch
Cancers 2022, 14(10), 2449; https://doi.org/10.3390/cancers14102449
Received: 29 March 2022 / Revised: 13 May 2022 / Accepted: 14 May 2022 / Published: 16 May 2022
Cervical cancers is a human papillomavirus infection-induced gynecologic cancer. Due to the uneven access to prevention measures in the world, it is still a leading cause of cancer death in women in low- and middle-income countries. The mainstay of treatment for early-stage cervical cancers is upfront surgery. Clinical trials confirmed the place of adjuvant radiotherapy to improve disease control, but also highlighted the need for a careful selection of patients prior to surgery, in order to avoid the cumulative morbidities of each treatment. In locally advanced cervical cancers, the standard of care remains concurrent pelvic chemoradiotherapy followed by an image-guided adaptive brachytherapy boost allowing for dose escalation and leading to a very high probability of local control. Systemic failures remain a major concern, and neoadjuvant or adjuvant approaches in this context are discussed in the light of recent literature.
Globally, cervical cancers continue to be one of the leading causes of cancer-related deaths. The primary treatment of patients with early-stage disease includes surgery or radiation therapy with or without chemotherapy. The main challenge in treating these patients is to maintain a curative approach and limit treatment-related morbidity. Traditionally, inoperable patients are treated with radiation therapy solely and operable patients undergo upfront surgery followed by adjuvant (chemo) radiotherapy in cases with poor histopathological prognostic features. Patients with locally advanced cervical cancers are treated with concurrent chemoradiotherapy followed by an image-guided brachytherapy boost. In these patients, the main pattern of failure is distant relapse, encouraging intensification of systemic treatments to improve disease control. Ongoing trials are evaluating immunotherapy in locally advanced tumours following its encouraging efficacy reported in the recurrent and metastatic settings. In this article, clinical evidence of neoadjuvant and adjuvant treatments in cervical cancer patients is reviewed, with a focus on potential strategies to improve patients’ outcome and minimize treatment-related morbidity. View Full-Text
Keywords: cervical cancer; radiation oncology; brachytherapy; chemotherapy; immunotherapy cervical cancer; radiation oncology; brachytherapy; chemotherapy; immunotherapy
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MDPI and ACS Style

Zhou, Y.; Rassy, E.; Coutte, A.; Achkar, S.; Espenel, S.; Genestie, C.; Pautier, P.; Morice, P.; Gouy, S.; Chargari, C. Current Standards in the Management of Early and Locally Advanced Cervical Cancer: Update on the Benefit of Neoadjuvant/Adjuvant Strategies. Cancers 2022, 14, 2449. https://doi.org/10.3390/cancers14102449

AMA Style

Zhou Y, Rassy E, Coutte A, Achkar S, Espenel S, Genestie C, Pautier P, Morice P, Gouy S, Chargari C. Current Standards in the Management of Early and Locally Advanced Cervical Cancer: Update on the Benefit of Neoadjuvant/Adjuvant Strategies. Cancers. 2022; 14(10):2449. https://doi.org/10.3390/cancers14102449

Chicago/Turabian Style

Zhou, Yuedan, Elie Rassy, Alexandre Coutte, Samir Achkar, Sophie Espenel, Catherine Genestie, Patricia Pautier, Philippe Morice, Sébastien Gouy, and Cyrus Chargari. 2022. "Current Standards in the Management of Early and Locally Advanced Cervical Cancer: Update on the Benefit of Neoadjuvant/Adjuvant Strategies" Cancers 14, no. 10: 2449. https://doi.org/10.3390/cancers14102449

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