Morbidity of radical surgery and postoperative radiotherapy in cervical cancer

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.