Current Standards in the Management of Early and Locally Advanced Cervical Cancer: Update on the Benefit of Neoadjuvant/Adjuvant Strategies

Globally, cervical cancers continue to be one of the leading causes of cancer-related deaths. The primary treatment of patients with early-stage diseases includes surgery or radiation therapy with or without chemotherapy. The main challenge in treating these patients is to maintain a curative approach and limit treatment-related morbidities. Traditionally, inoperable patients are solely treated with radiation therapy, and operable patients with poor histopathological prognostic features undergo upfront surgery followed by adjuvant (chemo) radiotherapy. Patients with locally advanced cervical cancers are treated with concurrent chemoradiotherapy followed by an image-guided brachytherapy boost. In these patients, the main pattern of failure is distant relapse, encouraging the intensification of systemic treatments to improve disease control. Ongoing trials are evaluating immunotherapy in locally advanced tumors following its encouraging efficacy reported in the recurrent and metastatic settings. In this article, clinical evidences of neoadjuvant and adjuvant treatments in cervical cancer patients are reviewed, with a focus on potential strategies to improve patients’ outcomes and minimize treatment-related morbidity.