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Postoperative adjuvant radiation for cervix cancer: reflections on the evidence and a peep into the future
  1. Supriya Chopra1,
  2. Nilesh Ranjan2 and
  3. Prachi Mittal2
  1. 1 Department of Radiation Oncology, Advanced Centre for Treatment, Research and Education in Cancer (ACTREC), Tata Memorial Centre, Homi Bhabha National Institute, Maharashtra, India
  2. 2 Department of Radiation Oncology and Medical Physics, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Maharashtra, India
  1. Correspondence to Dr Supriya Chopra, Tata Memorial Hospital, Mumbai, Maharashtra 400012, India; supriyasastri{at}


Early stage cervical cancer, stages IB1–2 and IIA1, can be treated with (chemo)radiation and brachytherapy or radical hysterectomy with or without further adjuvant (chemo)radiation. In a carefully selected cohort for surgery, traditionally a small proportion of patients would need adjuvant (chemo)radiation so that the therapeutic ratio is maximized. However, advances in radiation technology, specifically intensity modulated radiotherapy, have led to a reduction in treatment related adverse events. Also, recent developments in risk stratification suggest using a lower threshold to offer adjuvant treatment to minimize pelvic relapse. These developments together present opportunities of not only re-examining the therapeutic ratio but also of further evolving postoperative risk stratification. This review article summarizes the current evidence on adjuvant treatment strategies and summarizes the key areas where research should be focused.

  • cervical cancer
  • radiation
  • brachytherapy

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  • Contributors SC, NR, and PM reviewed the literature and guidelines, and prepared the manuscript. SC reviewed the manuscript. SC is the corresponding author.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial, or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; internally peer reviewed.