Nathalia Mora‐Soto

Morbidity of radical surgery and postoperative radiotherapy in cervical cancer

AbstractCervical 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.

Inadvertent cervical cancer: a narrative review

Inadvertent cervical cancer, defined as infiltrative cervical carcinoma diagnosed after a simple hysterectomy for presumed benign disease, remains clinically significant yet understudied. Despite the potential for eradication of cervical carcinoma through vaccination, screening, and early treatment, disparities in health care access continue to result in preventable cases, some of which are identified only postoperatively. This condition has long been recognized, yet its management remains undefined and is supported primarily by low- or very low-quality evidence. Diagnostic failures often stem from inadequate preoperative evaluation, missed follow-up of abnormal screening results, and insufficient re-excision with conization when indicated. Social determinants of health, including race and ethnicity, socioeconomic status, and insurance status, contribute significantly to these lapses. The identification of invasive disease only postoperatively may negatively impact prognosis, even in early stages. Treatment strategies for inadvertent cervical cancer include observation, radiotherapy with or without chemotherapy, and completion surgery, such as lymph node assessment with or without parametrectomy. While retrospective studies suggest similar oncologic outcomes across some strategies (eg, additional surgery or radiotherapy), the absence of prospective trials limits definitive conclusions. Furthermore, morbidity and quality-of-life outcomes are frequently underreported. To support clinical decision-making, we propose a risk-based classification of this condition, categorizing patients as very low, low, medium, or high risk. Until stronger evidence emerges, treatment decisions should be individualized based on tumor features, surgical approach, and patient preferences. This review summarizes current evidence, highlights gaps in knowledge, and offers a pragmatic algorithm for managing this complex clinical entity.

Efficacy of topical treatments for high-risk human papillomavirus in preventing CIN II+ lesions: a systematic review

This study aimed to systematically review the literature regarding topical therapies for reducing the risk of cervical intra-epithelial neoplasia (CIN) grade 2 or higher (CIN II+) lesions among women with high-risk human papillomavirus (HPV) infection and histologically confirmed CIN I or either no cervical lesions. We conducted a systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and registered the protocol in PROSPERO (CRD42024629608). We searched Ovid MEDLINE, Ovid EMBASE, Cochrane Central, and ClinicalTrials.gov from inception through December 16, 2024 for randomized controlled trials evaluating any cervical topical treatment in women with high-risk HPV and, at most, CIN I. The primary outcome was progression to histologically confirmed CIN II+. Secondary outcomes were treatment-related adverse events. Of 305 records, 19 full-text articles were reviewed. Finally, 16 trials were assessed. None met all our eligibility criteria, with some trials being excluded for multiple reasons. Twelve were excluded due to an inadequate study population (included women with CIN II+, lacked histologic confirmation of lesion grade, or lacked confirmatory high-risk HPV testing), 4 used inappropriate interventions, and 2 did not include a placebo or watchful waiting comparator. Although many studies reported HPV clearance or cytologic regression, none were powered or designed to assess progression to CIN II+. The current evidence from randomized trials is insufficient to determine whether topical cervical therapies reduce the risk of progression to CIN II+ in women with high-risk HPV infection. Future trials should prioritize histologic outcomes and adhere to current management protocols to establish the clinical utility of such therapies.