Adjuvant Treatment for Surgically-Treated Cervical Cancer Patients: A Comprehensive Review

Cervical cancer (CC) is the fourth most common gynecologic malignancy, affecting dis-proportionately women in low- and middle-income countries. Despite the effectiveness of HPV vaccination and screening strategies, CC poses a major global health issue, ac-counting for approximately 94% of annual deaths. Τhis review aims to summarize current evidence regarding adjuvant treatment indications for surgically treated cervical cancer patients and identify areas where further research is required. Through literature search a comprehensive review of existing guidelines, clinical trials and cohorts studies related to cervical cancer treatment was conducted, focusing on the role of adjuvant therapy in patients classified as low-, intermediate-, and high-risk for recurrence, who may require no further treatment. Adjuvant therapy is generally unnecessary for low-risk patients, while high-risk patients with lymph node invasion, parametrial involvement, or large tumor size require chemoradiation (CTRT). Ιntermediate-risk patients fall into a grey zone where the necessity of adjuvant therapy is still debatable. Guidelines emphasize the need for individualization in treatment strategies, since based on the published studies careful surgery alone and observation can provide similar outcomes to adjuvant therapy. This review emphasizes that achieving monotherapy remains pivotal to optimize outcomes and minimize overtreatment. Definitive adjuvant treatment is indicated for high-risk cases, intermediate-risk patients may benefit from careful observation following adequate surgical intervention, pointing out the necessity of well-designed clinical trials.