The role of adjuvant chemotherapy in the treatment of cervical cancer

Radical hysterectomy or trachelectomy remains the main treatment for stage I–II cervical cancer. In case of high and, in some cases, intermediate risk of cancer progression, adjuvant radiotherapy (ART) or chemoradiotherapy (ACRT) is performed after surgery, which increases disease free survival (DFS) and overall (OS) survival. However, the use of radiotherapy is associated with a risk of toxicity including serious late complications: vesicovaginal and rectovaginal fistulas, intestinal and ureteral strictures, radiation-induced tumors. The combination of surgery and radiotherapy increases the risk of toxicity, which dramatically reduces the quality of life of patients; the correction of complications may be ineffective and traumatic. All these factors necessitate the search for new approaches to the treatment of early-stage cervical cancer, which would ensure greater safety and higher quality of life for patients without long-term complications. One of these approaches is to reduce the need for ART / ACRT, by means of performance of type III / C2 surgery and partial replacement of ART / ACRT with adjuvant chemotherapy (ACT). Type III / C2 surgery eliminates the need for ART in patients with intermediate risk of disease progression and results in a 5-year OS > 90 % in patients with IB-IIA stage disease. The high-quality and large-scale studies demonstrated similar effectiveness of ACT compared to ART / ACRT. With no significant differences in OS and DFS, ACT provided a higher quality of life for patients. ACT is performed only if the quality of preoperative examination and findings as well as the quality of surgery, and conclusive results of pathology tests are undoubted. Further randomized studies are needed to better understand and clarify the indications for AСT.