Treatment of Locally Advanced Cervical Cancer — Bulky FIGO Stage IB2, IIB, IIIB or IVA

Cervical cancer presenting at bulky FIGO stages IB2, IIB, IIIB, or IVA constitutes the locally advanced disease group. This staging range defines a specific clinical situation that calls for a dedicated first-line treatment approach distinct from early-stage management.

Clinical scenario: Bulky FIGO stage IB2, IIB, IIIB, or IVA locally advanced cervical cancer. Chemoradiotherapy (CRT) has represented the standard of care in this setting for almost two decades, with strong evidence of benefit in both disease-free and overall survival compared to radiation alone.

The primary strategy in this setting centres on concurrent chemoradiotherapy, with radiation planning guided by surgical staging or imaging. An alternative approach using neoadjuvant chemotherapy followed by definitive local treatment is also recognised in specific cases. The full sequencing, eligibility criteria, and individualisation details are available in the complete protocol.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1093/annonc/mdx220

CRT has been the standard of care for patients with bulky IB2–IVA disease for almost two decades, demonstrating an improvement in both DFS and OS with concomitant chemotherapy and RT over standard RT/hydroxyurea [I, A].
The most commonly used regimen is weekly cisplatin 40 mg/m², although the meta-analysis also reported significant benefits with non-platinum agents [I, A].
Study results indicate that NACT may offer a benefit over surgery alone in cervical cancer patients, reducing the need for adjuvant RT [I, C].

View source ↗