[Adjuncts to surgery in cervical cancer]

Beside radiotherapy, radical hysterectomy with pelvic lymph node dissection is the cornerstone of early cervical cancer management. Surgery allows for more accurate evaluation of tumor extension as compared to non-invasive procedures preceding definite radiotherapy. Treatment failures after surgery include local-regional recurrences and distant metastases, and their proportion varies in particular series. In this study, we address the risk factors for recurrence in early-stage cervical cancer patients managed with primary surgery: lymph node positivity, deep stromal invasion, lymphovascular space involvement and positivity of surgical margins. Based on both retrospective and randomized studies, currently two adjuncts to surgery: radiotherapy and chemotherapy, used alone or in combination are employed. The indications for these approaches are reviewed. Additionally, the recommendations of American Brachytherapy Society for the use of postoperative brachytherapy are presented.