Treatment of Cervical Cancer at Stage T2b to T4a

This protocol applies to patients with locally advanced cervical cancer staged T2b to T4a — tumours that have extended beyond the cervix and may involve adjacent pelvic structures, but without distant metastasis. Managing this stage requires a coordinated, multi-modality approach guided by the extent of local disease.

Stages T2b through T4a represent a spectrum of locally advanced disease in which the tumour has grown beyond the cervix into the parametrium, pelvic wall, or adjacent organs. Definitive radiotherapy should include concomitant chemotherapy whenever possible at these stages.

The definitive approach for this stage range involves external beam radiotherapy combined with concurrent systemic therapy, together with image-guided adaptive brachytherapy as an essential component.

For more advanced substages within this range, additional systemic agents may be incorporated into both the concurrent and maintenance phases of treatment. The complete structured regimen — including all agents, sequencing, and stage-specific considerations — is available in the full protocol.