Morbidity of radical surgery and postoperative radiotherapy in cervical cancer
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Date
2024-12-13
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Abstract
Cervical cancer is among the most common cancers affecting women worldwide.
The standard treatment for early-stage cervical cancer (International Federation of
Gynecology and Obstetrics [FIGO] 2018 stages IA1–IB2, IIA1) typically involves a rad ical or simple hysterectomy with lymph node assessment. Postoperative management
may include observation or tailored adjuvant therapy, such as radiotherapy or chemo radiotherapy, depending on individual pathological risk factors. However, these inter ventions are associated with significant complications: surgical management can lead
to urinary and sexual dysfunction, lymphocysts, and lower limb lymphedema, while
radiotherapy may cause genitourinary, gastrointestinal, and sexual toxicities. Less radical surgery for selected cases could reduce surgical morbidity and advances in
radiotherapy techniques, such as intensity-modulated radiotherapy, volumetric mod ulated arc therapy, and other three-dimensional conformal radiation therapies, have
the potential to enhance precision and reduce toxicity. Nonetheless, the morbidity
associated with combining radical surgery and adjuvant (chemo)radiotherapy remains
an area of uncertainty, particularly in light of these emerging technologies. Most cur rent data on this topic derive from retrospective studies involving heterogeneous
populations and inconsistent quality-of-life assessment methods. Prospective studies
employing standardized morbidity assessment tools are essential to determine the
true impact of combined treatments compared to single-modality approaches. Future
research should prioritize understanding the long-term effects of these treatment
strategies, aiming to minimize adverse outcomes while maintaining optimal oncologi cal control.
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Keywords
adjuvant radiotherapy, cervical cancer, intensity-modulated radiation therapy (IMRT), lymphedema, postoperative complications, radical hysterectomy, sexual dysfunction, treatment morbidity