Controversies in the radiotherapeutic management of cervical cancer

Radiotherapy is a critical component of treatment for many patients with cervical cancer. The role of concurrent cisplatin-based chemotherapy in the majority of cases where radiotherapy is indicated has been established. However, optimal planning and delivery of radiotherapy require attention to multiple factors beyond combined-modality chemoradiation and the continuing search for novel and effective synergistic systemic agents. Several important issues surrounding radiotherapy for cervical cancer that require clarification include the following: the effect of anemia and tumor hypoxia on outcome and their potential as therapeutic targets, the appropriate incorporation of contemporary imaging and high-technology treatment planning systems in routine clinical practice, the role of prophylactic para-aortic radiation, and the role of radioprotectors. Ongoing and newly proposed studies are expected to provide insights into these questions, which will ultimately lead to enhanced radiotherapeutic and overall care for patients with cervical cancer.