Recent Management of FIGO stage IB2 Cervical Cancer

Chung, Hyun Hoon; Kim, Jae Weon

Abstract

The treatment of patients with bulky stage IB2 cervical cancer is a therapeutic challenge. Neither of local treatment such as radical hysterectomy nor primary radiation therapy is sufficiently effective, and also is associated with significant treatment-related complications. A number of phase III studies have investigated alternative management approaches in this patient population. Consistent with results seen in locally advanced cervical cancer, chemoradiation therapy is superior to radiation therapy alone as primary treatment for stage IB2 cervical cancer, and as adjuvant therapy for surgically treated patients with high-risk factors for recurrence. Neoadjuvant chemotherapy has resulted in high clinical response rates and operability rates in patients with stage IB2 cervical cancer. There are two phase III clinical trials suggesting an improvement in survival with neoadjuvant chemotherapy followed by radical hysterectomy versus either surgery (and/ or postoperative radiation) or radiation therapy alone. Pretreatment laparoscopic surgical staging in stage IB2 cervical cancer can be used as a guideline for individualized therapy. These emerging treatments should be investigated in prospective controlled trials.