Radiochemotherapy or surgery for cervical cancer-what and when?

Background Although the incidence of cervical cancer in Germany will continue to decline in the long term despite poor vaccination rates, it remains a global health problem with more than 500,000 new cases worldwide. Objective Portrayal of the stage-dependent significance of primary and adjuvant chemoradiation in cervical cancer patients. Materials and methods A detailed literature review regarding treatment options for different stages of cervical cancer was conducted. In particular, the selection of the treatment options primary hysterectomy (HE) followed by radiochemotherapy, primary combined radiochemotherapy and neoadjuvant chemotherapy followed by HE versus radiochemotherapy was analyzed for oncologic result, treatment-related toxicity, and quality of life. Results Radical HE should be performed in appropriately selected patients and adjuvant radiochemotherapy should be avoided. So-called trimodal therapy contributes to a doubling of long-term side effects of therapy. Neoadjuvant chemotherapy for locally advanced tumors should be performed in the context of the open ARO (Arbeitsgemeinschaft Radiologische Onkologie)-AGO (Arbeitsgemeinschaft Gynakologische Onkologie)-NOGGO (Nord-Ostdeutsche Gesellschaft fur Gynakologische Onkologie) study. Concerning the quality of life in younger patients, ovariopexy should be considered before radiochemotherapy. Patients with histologically confirmed para-aortic metastases may benefit from a systematic lymphadenectomy before extended-field radiochemotherapy. Conclusion Interdisciplinary coordination, patient information, and treatment by an experienced team should become a matter of course.