This protocol applies to patients with cervical cancer staged as T1b1, T1b2, or T2a1 who are being considered for post-surgical adjuvant management. Treatment decisions are driven by findings at final pathology.
Post-surgical management is stratified by final-pathology risk group. Depending on the risk category — each defined by a specific set of pathological findings — different radiotherapy-based approaches are indicated for some patients, while observation may be appropriate in others. The full risk-stratified protocol is available below.
Lymph node assessment should be performed as the first step of surgical management.
Adjuvant radiotherapy should be considered in the intermediate risk group (combination of risk factors at final pathology, such as tumor size, lymphovascular space involvement, and depth of stromal invasion).
When an adequate type of radical hysterectomy has been performed in intermediate risk group patients, observation is an alternative option, especially in teams experienced in this approach.
Adjuvant chemoradiotherapy is indicated in the high-risk group.
Additional brachytherapy boost as part of adjuvant conformal radiotherapy can be considered in cases with vaginal and/or parametrial positive disease.
DOI: 10.1016/j.ijgc.2025.102747
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