Indications for adjuvant radiotherapy treatment after surgery and novel modalities for treatment

Carcinoma of the uterine cervix is a frequent common cancer in women. Patients diagnosed with early stage cervix cancer are managed with surgery. Overall survival for stage IB (IB1-IB2) and IIA, is in the range of 80-90% at 5 years. Only patients with poor prognostic factors as: large tumors (>or=4 cm), positive lymph nodes, positive and/or close margins <3 mm; can benefit from adjuvant radiotherapy. Radiotherapy has been also recommended for a subgroup of patients with intermediate-risk factors as: large tumor diameter, deep stromal invasion and presence of tumor in capillary lymphatic space adjuvant. In the presence of 2 of the 3 adverse risk factors, radiotherapy reduces tumor recurrence in stage IB cervical cancer with negative lymph nodes. Radiotherapy plays an important role in the management of cervical cancer. Conventional radiotherapy may treat a large amount of normal tissue resulting in acute toxicity. The most frequent acute adverse events after external three-dimensional radiotherapy are bowel, bladder and hematological side effects. With standard doses of external beam radiotherapy 45 Gy-50 Gy (1.8 Gy-2 Gy) grade 3-4 late toxicity occurs in about 10%-12%. Intensity modulated radiation therapy (IMRT) represents an advance in treatment delivery with doses that conform tightly to the target, and may reduce the acute gastrointestinal and chronic toxicity when compared with conventional 3D radiotherapy. Also IMRT treats less bone marrow and may lead to a better tolerance of chemotherapy.