Different strategies of treatment for uterine cervical carcinoma stage IB2-IIB

Table 1 Institutional capabilities, advantages and disadvantages of the main strategies of treatment for treating locally advanced cervical cancer International Federation of Gynecology and Obstetrics stage IB2-IIB

	Institutional capabilities	Advantages	Disadvantages
CT-RT	Well radiotherapy equipment (ideally, intensity-modulated radiotherapy IMRT) Availability of schedule for radiotherapy	Well-documented oncologic benefit over radiotherapy alone Standardized treatment	Limited benefit in case of delay of treatment for toxicity or difficult access to radiation treatment (schedule, few equipment, etc.) Possible permanent local toxicity of radiotherapy, mainly in young and sexually active women
NACT + RS	Welltrained surgeons Institutional support for complex surgical procedure (Intensive care units, Urologists, Internist, etc.)	Reduce the tumor size Control of metastasis Select chemosensitive patients (prognostic factor) Allow to spare RT for relapsed disease or chemorefractory patients	Delay local treatment such as RT or RS selection of resistant cells clones chemotherapy-induced immunosuppression Negative lymph nodes at RS Cumulative toxicity of multimodal treatment, mainly in case of adding postoperative RT
Chemoradiation + adjuvant chemotherapy	Similar to CT-RT strategy	Possible but not welldocumented benefit yet (limited trials)	Similar to chemoradiation cumulative toxicity of multimodal treatment

NACT: Neoadjuvant chemotherapy; RS: Radical surgery; IMRT: Intensity-modulated radiotherapy; CT-RT: Chemoradiation.