Clinical Management of Cervical Cancer

A special issue of Current Oncology (ISSN 1718-7729). This special issue belongs to the section "Gynecologic Oncology".

Deadline for manuscript submissions: 30 June 2025 | Viewed by 2494

Special Issue Editor


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Guest Editor
CHUM, CRCHUM, Université de Montréal, Montreal, QC H2X 3E4, Canada
Interests: gynecological cancers; ERAS; clinical trials

Special Issue Information

Dear Colleagues,

Cervical cancer is the fourth most common cancer among women, with over 660,000 new cases diagnosed globally and close to 350,000 deaths annually, and a heavier burden in low- and middle-income countries (1). While the World Health Organization (WHO) has set up a global strategy for cervical cancer elimination (2), clinical treatments have also significantly evolved in recent years, to become more personalized, improve clinical outcomes and reduce treatment side effects.

FIGO’s revised cervical staging of 2018, considering radiological and pathological findings, enhanced a shift to better characterization of the disease. Today, molecular biomarkers are being developed to guide treatment as well as surveillance. Although clinical treatment strategies might differ from one region to another, new data have emerged to support clinical treatment strategies. Considering surgical treatment of early-stage cervical cancers, de-escalation may now apply to the type of hysterectomy or nodal staging performed, while surgical routes should be chosen carefully. Regarding the management of metastatic or recurrent disease, immunotherapy now plays a key role. This Special Issue will highlight these clinical aspects.

  1. (Global Cancer Observatory (GCO), https://gco.iarc.who.int/media/globocan/factsheets/cancers/23-cervix-uteri-fact-sheet.pdf).
  2. https://www.who.int/initiatives/cervical-cancer-elimination-initiative; https://www.who.int/publications/i/item/9789240014107.

Dr. Vanessa Samouëlian
Guest Editor

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Keywords

  • cervical cancer
  • surgical treatments
  • de-escalation
  • systemic treatments
  • immunotherapy
  • biomarkers
  • personalized treatment

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Published Papers (3 papers)

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19 pages, 1549 KiB  
Article
Clinical Impact of MRI-Guided Intracavitary–Interstitial Brachytherapy in the Curative Management of Advanced-Stage Cervical Cancer
by Antje Wark, Laura Hüfner, Eva Meixner, Jan Oelmann, Laila König, Simon Höne, Katja Lindel, Jürgen Debus and Nathalie Arians
Curr. Oncol. 2025, 32(3), 136; https://doi.org/10.3390/curroncol32030136 - 26 Feb 2025
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Abstract
This study investigates the clinical efficacy of MRI-based adaptive brachytherapy (IGABT) using combined intracavitary and interstitial techniques in the curative treatment of patients with advanced cervical cancer (LACC). A retrospective analysis was conducted on 149 LACC patients treated at a single center. The [...] Read more.
This study investigates the clinical efficacy of MRI-based adaptive brachytherapy (IGABT) using combined intracavitary and interstitial techniques in the curative treatment of patients with advanced cervical cancer (LACC). A retrospective analysis was conducted on 149 LACC patients treated at a single center. The therapeutic protocol included intensity-modulated external beam radiotherapy (IMRT) and IGABT. Dosimetric parameters were evaluated for relevance for local control (LC), progression-free survival (PFS), and overall survival (OS) using Kaplan–Meier estimation, Cox regression, and log-rank test. Patients predominantly presented with stage III/IV tumors (81%, FIGO 2018). The median high-risk clinical target volume (hrCTV) was 34 cm3, with a median D90% dose of 88.9 GyEQD2. At 24 months, OS, PFS, and LC rates were 86%, 57%, and 81%, respectively. FIGO stage, tumor volume, and histology were significant predictors of PFS. Higher total hrCTV doses were strongly correlated with improved LC and PFS, emphasizing the importance of precise dosimetric optimization in IGABT and confirming the critical role of IGABT in achieving very good LC rates for LACC. The reported LC rates are comparable to landmark studies, such as INTERLACE and KEYNOTE-A18. This study validates the effectiveness of MRI-guided IGABT in enhancing local tumor control in advanced-stage cervical cancer while providing insights into the prognostic implications of dosimetric parameters such as hrCTV and point A. Future research should address the persistent challenge of distant metastases by exploring the integration of novel systemic treatment options. Full article
(This article belongs to the Special Issue Clinical Management of Cervical Cancer)
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14 pages, 1160 KiB  
Article
Comprehensive Evaluation of Inflammatory Biomarkers in Cervical Cancer Treated with Chemoradiotherapy
by Timur Koca, Nurcihan Gocen Vardar, Rahmi Atıl Aksoy and Aylin Fidan Korcum
Curr. Oncol. 2025, 32(1), 39; https://doi.org/10.3390/curroncol32010039 - 13 Jan 2025
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Abstract
Objective: Inflammatory biomarkers have been shown to possess both prognostic and predictive significance in various cancers. Among the emerging biomarkers, the pan-immune-inflammation value (PIV) has recently been introduced as a novel indicator representing both the immune response and the systemic inflammatory state. [...] Read more.
Objective: Inflammatory biomarkers have been shown to possess both prognostic and predictive significance in various cancers. Among the emerging biomarkers, the pan-immune-inflammation value (PIV) has recently been introduced as a novel indicator representing both the immune response and the systemic inflammatory state. This study aims to comprehensively evaluate the predictive value of inflammatory biomarkers on survival outcomes in cervical cancer patients undergoing chemoradiotherapy. Methods: A total of 90 patients who had undergone chemoradiotherapy for cervical cancer were included. Data on demographics, treatment protocols, pre-treatment blood parameters, and survival outcomes were collected. The association between inflammatory biomarkers and survival outcomes was investigated through univariate and multivariate analyses. Results: The univariate analysis identified the following as predictors of progression-free survival (PFS): neutrophil–lymphocyte ratio (NLR), platelet–lymphocyte ratio (PLR), monocyte–lymphocyte ratio (MLR), systemic immune-inflammation index (SII), PIV, C-reactive protein (CRP), albumin, and tumor size. Multivariate analysis revealed that only the PIV significantly predicted PFS (HR 3.05, 95% CI 1.0 to 9.3, p = 0.04). In the univariate analysis, several variables were predictive of overall survival (OS), including NLR, PLR, MLR, SII, PIV, CRP, LDH, albumin, tumor size, and Eastern Cooperative Oncology Group Performance Status (ECOG PS). Multivariate analysis revealed CRP (HR 3.41, 95% CI 1.5 to 7.7, p = 0.003) and ECOG PS (HR 4.78, 95% CI 1.3 to 17.3, p = 0.01) predictive of OS, with PIV approaching statistical significance (HR 2.56, 95% CI 0.8 to 7.6, p = 0.09). Conclusions: This study provides the first comprehensive analysis of the association between cervical cancer and various inflammatory biomarkers. Many of these biomarkers have demonstrated predictive value for survival outcomes in patients with cervical cancer undergoing definitive chemoradiotherapy. Among the biomarkers evaluated, CRP and PIV were identified as the most predictive, warranting further exploration in future research. Full article
(This article belongs to the Special Issue Clinical Management of Cervical Cancer)
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18 pages, 1863 KiB  
Systematic Review
A Systematic Review of SBRT Boost for Cervical Cancer Patients Who Cannot Benefit from Brachytherapy
by Iozsef Gazsi and Loredana G. Marcu
Curr. Oncol. 2025, 32(3), 170; https://doi.org/10.3390/curroncol32030170 - 15 Mar 2025
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Abstract
Stereotactic body radiation therapy has emerged as a promising alternative to brachytherapy, delivering high doses to tumors with precision while sparing surrounding organs. This systematic review evaluates the role of SBRT as a boost for patients who are ineligible for brachytherapy. A total [...] Read more.
Stereotactic body radiation therapy has emerged as a promising alternative to brachytherapy, delivering high doses to tumors with precision while sparing surrounding organs. This systematic review evaluates the role of SBRT as a boost for patients who are ineligible for brachytherapy. A total of 17 studies, involving 288 patients, were analyzed, focusing on dosimetric parameters and toxicity. The radiation regimens varied in dose and fractionation schedules, with external beam doses ranging from 44 to 61.6 Gy, and SBRT boost doses ranging from 5 to 30 Gy. The total EQD2 doses were between 50.5 and 92.4 Gy. The results indicate adequate tumor control with SBRT, with local control rates ranging from 57% to 95.5%. The acute genitourinary and gastrointestinal toxicities were mostly grade 1 or 2, while late toxicities were less common. The overall survival rates varied between 34% and 96%. These results suggest that SBRT boost offers a viable option for cervical cancer patients ineligible for brachytherapy, with acceptable toxicity and promising survival outcomes. Nevertheless, the scarcity of data, which mainly originate from small studies with patients having varied stages of disease, as well as the lack of long-term follow up with SBRT, should encourage clinicians to utilize brachytherapy whenever suitable as a boost in these patient cohorts. Full article
(This article belongs to the Special Issue Clinical Management of Cervical Cancer)
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