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Living with cancer·Standard of care

Locally advanced cervical cancer: the decisions you may face

Cancer page →Second-opinion finder →

6 treatment settings, 6 with more than one named option. Each section lays out the options the standard of care names, what each is for, the trials behind them with their recorded results, the side effects and cautions on record, and questions to ask. Built from the cancer page's standard-of-care rows; nothing here is advice for your case.

Other settings

Standard chemoradiation

3 options

Weekly cisplatin with pelvic external-beam radiotherapy followed by image-guided brachytherapy, completed within eight weeks.

The options, in plain words
CisplatinApprovedCytotoxic chemotherapy (platinum)

Cisplatin is the original platinum chemotherapy, discovered by accident in 1965; it cures testicular cancer and makes radiation work better in cervical and head and neck cancer.

IMRT / IGRT (modern external beam)Standard of care

IMRT and IGRT shape the radiation beam to the tumour's outline from multiple angles and check the patient's position with a scan before every session, so surrounding organs receive less dose. Fewer, larger doses are now standard in breast and prostate cancer, but a low-dose bath still spreads across normal tissue.

  • Conformal dose, fewer side effects
  • Hypofractionation saves visits
BrachytherapyStandard of care

Brachytherapy places a radioactive source directly inside or next to the tumour.

  • Highest conformality
  • Short treatment
Also referenced:Chemoradiation (chemoradiotherapy, CRT)Radiotherapy
The evidence behind it

No trial record is attached to this row yet. The trials tab lists what is recruiting and the landmark trials for this cancer.

The main trade-offs on record
Cisplatinall recorded rates →
  • Dose reduce or avoid for CrCl below 60 (carboplatin is the alternative).
IMRT / IGRT (modern external beam)
  • Low-dose bath to normal tissue
  • Motion management
Brachytherapy
  • Invasive
  • Declining expertise in some regions
Questions to ask about this decision
  1. Between Cisplatin, IMRT / IGRT (modern external beam) and Brachytherapy, which do you recommend for me, and what about my case would make you choose differently?
    Why: Guidelines list several reasonable options; the choice turns on details of your tumour, your health and your priorities.
  2. What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?
    Why: The aim shapes how much side effect and disruption is worth accepting.
  3. What happens if I delay, or decline this step for now? Is the decision reversible?
    Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
  4. For my situation (standard chemoradiation), which of the standard options do you recommend and why?
    Why: Guideline options include: Weekly cisplatin with pelvic external-beam radiotherapy followed by image-guided brachytherapy, completed within eight weeks.
  5. Am I a candidate for Cisplatin, and what side effects should I expect?
    Why: Knowing the expected toxicities helps you plan work, family, and supportive care.

Add these to your appointment list, or take the full question set for this cancer.

Early / localised

High-risk disease (node-positive IB2 to IIB, III to IVA)

3 optionsCompare side by side →

Pembrolizumab with chemoradiation and for up to two years afterwards (KEYNOTE-A18).

The options, in plain words
PembrolizumabApprovedMonoclonal antibody (anti-PD-1)

Pembrolizumab is a PD-1 blocking antibody approved in more than 40 settings, from melanoma and lung cancer to the first tumour-agnostic approval for mismatch-repair-deficient tumours in 2017, and before and after surgery in triple-negative breast cancer. A subcutaneous form arrived in 2025, and it is the backbone partner for ADCs and personalised neoantigen vaccines.

CisplatinApprovedCytotoxic chemotherapy (platinum)

Cisplatin is the original platinum chemotherapy, discovered by accident in 1965; it cures testicular cancer and makes radiation work better in cervical and head and neck cancer.

BrachytherapyStandard of care

Brachytherapy places a radioactive source directly inside or next to the tumour.

  • Highest conformality
  • Short treatment
Also referenced:PD-1 blockade + chemoradiation (locally advanced cervical cancer)
The evidence behind it
The main trade-offs on record
Pembrolizumaball recorded rates →
Side effectAny gradeGrade 3+
Hypothyroidism (immune-mediated) · Pooled monotherapy data, >2,800 patients8%-
Pneumonitis (immune-mediated) · Pooled monotherapy data, >2,800 patients3.4%-
Colitis (immune-mediated) · Pooled monotherapy data, >2,800 patients1.7%-
Hepatitis (immune-mediated) · Pooled monotherapy data, >2,800 patients0.7%-
  • No pharmacokinetic interactions expected (antibody). See the irAE guide for toxicity management.

Rates from the label or pivotal trial as recorded on the product page; each grade 3+ figure links to its source.

Cisplatinall recorded rates →
  • Dose reduce or avoid for CrCl below 60 (carboplatin is the alternative).
Brachytherapy
  • Invasive
  • Declining expertise in some regions
Questions to ask about this decision
  1. Between Pembrolizumab, Cisplatin and Brachytherapy, which do you recommend for me, and what about my case would make you choose differently?
    Why: Guidelines list several reasonable options; the choice turns on details of your tumour, your health and your priorities.
  2. What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?
    Why: The aim shapes how much side effect and disruption is worth accepting.
  3. How closely do I match the people in KEYNOTE-A18 / ENGOT-cx11 / GOG-3047, and does that change what the results mean for me?
    Why: Trial populations are selected; age, fitness, prior treatment and biomarkers all affect how far results carry.
  4. Which side effects of Pembrolizumab are most likely for me, which are reversible, and which would make us stop?
    Why: The recorded rates below come from labels and trials; your own risk depends on dose, other medicines and your health.
  5. What happens if I delay, or decline this step for now? Is the decision reversible?
    Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
  6. For my situation (high-risk disease (node-positive ib2 to iib, iii to iva)), which of the standard options do you recommend and why?
    Why: Guideline options include: Pembrolizumab with chemoradiation and for up to two years afterwards (KEYNOTE-A18).
  7. Am I a candidate for Pembrolizumab, Cisplatin, and what side effects should I expect?
    Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
  8. How do the results of KEYNOTE-A18 / ENGOT-cx11 / GOG-3047 apply to someone like me?
    Why: Trial populations differ from individual patients; ask how closely you match.

Add these to your appointment list, or take the full question set for this cancer.

Advanced, first line

Induction option

2 optionsCompare side by side →

Six weekly cycles of carboplatin-paclitaxel before chemoradiation (INTERLACE), particularly where immunotherapy is not available.

The options, in plain words
CarboplatinApprovedCytotoxic chemotherapy (platinum)

Carboplatin is a platinum chemotherapy that crosslinks DNA; it is part of the standard pre-surgery regimen for triple-negative breast cancer.

Paclitaxel / nab-paclitaxelApprovedCytotoxic chemotherapy (taxane)

A microtubule poison discovered in the Pacific yew tree, among the most used chemotherapies in breast, lung, and ovarian cancer.

Also referenced:Induction chemotherapy → chemoradiation (locally advanced cervical cancer)
The evidence behind it
  • INTERLACEPhase 3NCT015662402023500 peopleevidence 87
    Tests Carboplatin, Paclitaxel / nab-paclitaxel
    Locally advanced cervical cancer: 6 weeks of induction carboplatin-paclitaxel before chemoradiation vs chemoradiation alone
    Show survival figures (1)

    Averages across everyone diagnosed, often years ago. Your stage, subtype, age, fitness and the treatment you receive matter more than the average, and the numbers are improving quickly.

    • 5-year OS 80% vs 72% (HR 0.60); PFS HR 0.65.
    Progression-free survival at 5 years (%): Induction chemo + CRT 72 (n=250) vs CRT alone 64 (n=250) · HR 0.65 · source
The main trade-offs on record
Carboplatinall recorded rates →
  • Dose by Calvert formula using GFR (see the calculators).
Questions to ask about this decision
  1. Between Carboplatin and Paclitaxel / nab-paclitaxel, which do you recommend for me, and what about my case would make you choose differently?
    Why: Guidelines list several reasonable options; the choice turns on details of your tumour, your health and your priorities.
  2. What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?
    Why: The aim shapes how much side effect and disruption is worth accepting.
  3. How closely do I match the people in INTERLACE, and does that change what the results mean for me?
    Why: Trial populations are selected; age, fitness, prior treatment and biomarkers all affect how far results carry.
  4. What happens if I delay, or decline this step for now? Is the decision reversible?
    Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
  5. For my situation (induction option), which of the standard options do you recommend and why?
    Why: Guideline options include: Six weekly cycles of carboplatin-paclitaxel before chemoradiation (INTERLACE), particularly where immunotherapy is not available.
  6. Am I a candidate for Carboplatin, Paclitaxel / nab-paclitaxel, and what side effects should I expect?
    Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
  7. How do the results of INTERLACE apply to someone like me?
    Why: Trial populations differ from individual patients; ask how closely you match.

Add these to your appointment list, or take the full question set for this cancer.

2 options

Pelvic MRI and whole-body PET-CT; surgical para-aortic staging in selected cases.

The options, in plain words
MRIStandard of care

MRI uses a strong magnet and radio waves, with no ionising radiation, to picture soft tissue in finer contrast than CT, so it is the standard scan for brain tumours, prostate, rectal cancer staging, liver lesions and breast screening in high-risk women. It is slow, expensive and blurred by movement.

  • No ionising radiation
  • Best soft-tissue and brain imaging
  • Functional sequences (diffusion, perfusion)
PET/CTStandard of care

PET and CT in one machine, so hot spots on the PET are pinned to exact locations on the CT.

  • Anatomy plus biology
  • Standard for lymphoma, lung, melanoma, head and neck staging
Also referenced:Laparoscopy (keyhole surgery)
The evidence behind it

No trial record is attached to this row yet. The trials tab lists what is recruiting and the landmark trials for this cancer.

The main trade-offs on record
MRI
  • Slow and expensive
  • Motion artefacts
  • Gadolinium concerns in renal impairment
PET/CT
  • CT radiation added to PET dose
Questions to ask about this decision
  1. Between MRI and PET/CT, which do you recommend for me, and what about my case would make you choose differently?
    Why: Guidelines list several reasonable options; the choice turns on details of your tumour, your health and your priorities.
  2. What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?
    Why: The aim shapes how much side effect and disruption is worth accepting.
  3. What happens if I delay, or decline this step for now? Is the decision reversible?
    Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
  4. For my situation (staging), which of the standard options do you recommend and why?
    Why: Guideline options include: Pelvic MRI and whole-body PET-CT; surgical para-aortic staging in selected cases.

Add these to your appointment list, or take the full question set for this cancer.

Second line

Central pelvic recurrence after radiotherapy

3 options

Pelvic exenteration in selected patients; re-irradiation with brachytherapy or protons in specialist centres.

The options, in plain words
BrachytherapyStandard of care

Brachytherapy places a radioactive source directly inside or next to the tumour.

  • Highest conformality
  • Short treatment
Proton therapyEstablished

Radiation using protons, which stop inside the tumour instead of passing through, so tissue behind it gets no dose.

  • No exit dose; lower integral dose
  • Reduced second cancers in children
Robotic & minimally invasive surgeryStandard of care

Surgeons operate through small incisions using robotic arms with tremor-free precision and 3D vision.

  • Precision, shorter stay
  • Enables complex minimally invasive resections
The evidence behind it

No trial record is attached to this row yet. The trials tab lists what is recruiting and the landmark trials for this cancer.

The main trade-offs on record
Brachytherapy
  • Invasive
  • Declining expertise in some regions
Proton therapy
  • Cost
  • Range uncertainty
  • Limited randomised evidence in adults
Robotic & minimally invasive surgery
  • Cost
  • Loss of haptic feedback
  • Not superior for every indication
Questions to ask about this decision
  1. Between Brachytherapy, Proton therapy and Robotic & minimally invasive surgery, which do you recommend for me, and what about my case would make you choose differently?
    Why: Guidelines list several reasonable options; the choice turns on details of your tumour, your health and your priorities.
  2. What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?
    Why: The aim shapes how much side effect and disruption is worth accepting.
  3. What happens if I delay, or decline this step for now? Is the decision reversible?
    Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
  4. For my situation (central pelvic recurrence after radiotherapy), which of the standard options do you recommend and why?
    Why: Guideline options include: Pelvic exenteration in selected patients; re-irradiation with brachytherapy or protons in specialist centres.

Add these to your appointment list, or take the full question set for this cancer.

How to read this page. Options and results come from OnCo records with their sources; the settings are the standard-of-care rows on the cancer page, and the lines of therapy are on the sequencing grid. Where a setting names one path, the choice is usually about timing, trials and where to be treated: see expert centres. OnCo is orientation, not medical advice.