Cervical Treatment Guidlines


  • Complete treatment within 8 weeks.
  • All patients who are medically fit and stage ≥IB2 should probably get concurrent cisplatin-based chemo and RT.
  • AdenoCa probably should not get chemo, outcome is same as SCCA stage for stage. Most ACA are younger who do worse

Treatment by Stage

== Surgeries for Cervical Cancer ==

Stage O:

TAH or conization in young women

Stage Ia1

Conization or Simple Hysterectomy IA1

  • Less than 1% risk of LN metastasis.
  • If the depth of invasionis < 3mm, no LVI, and margins (-). No further treatment.

Intracavitary radiation alone for IA1

  • < 3mm depth of invasion, no LVI.
  • T&O x 2 to 65-75 Gy to point A
  • Maximal vaginal surface dose of 100 to 120 Gy.

Stage Ia2, Ib1 and IIa (< 4 cm)

Radical Hysterectomy for IA2 or IB1 (category 1)

  • 3-5 mm depth has upto 10% risk of LN.(+).
  • Radical Hys + LN dissection for uncertain tumor invasion.

External 45 Gy + T&O x 2 for a point A dose of ≥ 85 Gy. (category 2B)
No chemotherapy needed (no evidence for it) for IA2 or IB1

Stage Ib2/IIa (> 4 cm)

Definitive Chemoradiation (category 1)

  • Pelvic 45 Gy + T&O x 2 for a point A dose of ≥ 85 Gy.
  • Local control 80%

Radical Hysterectomy and bilateral pelvic Lymphadenectomy (category 2B)

  • Local control 60% with surgery alone
  • Postoperative total pelvic irradiation + chemotherapy for pelvic nodes(+), margin(+), and residual parametrial disease (Landoni)

Stage IIb/III/Iva

Definitive Chemoradiation (category 1)

  • pelvic 45 Gy + T&O x 2 for a point A dose of ≥ 85 Gy.
  • See special cases


  • (LEFT A) Example of left parametrial implant used to boost the dose in a patient in whom only an afterloading tandem was placed in combination with whole pelvis and parametrial irradiation fro treatment of stage IIB carcinoma of the cervix
  • (RIGHT B) Example of aferloading iridium implant used to boost the right paravaginal and parametrial tissues in a patient with stage IIIB carcinoma of the cervix

Parametrial residual after external beam (II b.)

  • Parametrial boost to 54 to 66 Gy (see Parametrial boost section)
  • Need to keep bowel < 45 Gy
  • If extensive parametrial residual consider interstitial
  • The T&O is prescribed to 2 cm from the os up and out, point A, so you could still treat disease up to this point with a standard T&O.
  • If tumor is not covered by 80-85 Gy with T&O, then interstitial implant
  • The response is measured after 5 weeks of Chemo RT ( I always do a CT, MRI PREFERABLE). With Cispt now being added concurrently there is a tendency for the platelets to bottom out. We and others have noticed that this plateau tends to occur at 5 weeks, no published data, so doing a Syed is not without significant risks. Make sure you have a platelet draw the morning of the procedure (best), or the day before and look for a value of at least 100.
  • Another option if there is little response after 5 weeks of Chemo RT is a Rad Hys, but only after you mentioned the Syed… a Rad Onc exam.

Distal vaginal residual (III a.)

  • if < 5 mm of depth then tandem and cylinder to 85 Gy to vaginal mucosa
  • if > 5 mm of depth interstitial implants to 85 Gy to tumor volume while respecting vaginal tolerance
  • inguinal covered by external beam

Para-aortic (not part of WHO staging)

== Para-aortic Radiation ==

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