Morbidity of radical surgery and postoperative radiotherapy in cervical cancer

Cervical cancer is among the most common cancers affecting women worldwide. The standard treatment for early-stage cervical cancer (International Federation of Gynecology and Obstetrics [FIGO] 2018 stages IA1-IB2, IIA1) typically involves a radical or simple hysterectomy with lymph node assessment. Postoperative management may include observation or tailored adjuvant therapy, such as radiotherapy or chemoradiotherapy, depending on individual pathological risk factors. However, these interventions are associated with significant complications: surgical management can lead to urinary and sexual dysfunction, lymphocysts, and lower limb lymphedema, while radiotherapy may cause genitourinary, gastrointestinal, and sexual toxicities. Less-radical surgery for selected cases could reduce surgical morbidity and advances in radiotherapy techniques, such as intensity-modulated radiotherapy, volumetric modulated arc therapy, and other three-dimensional conformal radiation therapies, have the potential to enhance precision and reduce toxicity. Nonetheless, the morbidity associated with combining radical surgery and adjuvant (chemo)radiotherapy remains an area of uncertainty, particularly in light of these emerging technologies. Most current data on this topic derive from retrospective studies involving heterogeneous populations and inconsistent quality-of-life assessment methods. Prospective studies employing standardized morbidity assessment tools are essential to determine the true impact of combined treatments compared to single-modality approaches. Future research should prioritize understanding the long-term effects of these treatment strategies, aiming to minimize adverse outcomes while maintaining optimal oncological control.