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Overview of systemic treatment in recurrent and advanced cervical cancer: a primer for radiologists

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Abstract

Imaging has a central role in surveillance of cervical cancer, guiding decision on when to initiate treatment for recurrent disease and to guide management in advanced cervical cancer. Due to the increased availability of pelvic radiation therapy, the rate of atypical presentation of recurrent disease has increased. Simultaneously, the array of systemic therapies now available for advanced cervical cancer has considerably expanded in the last few years, with therapies now available in mid and low-income countries. While pelvic recurrences are amenable of loco-regional treatment, recurrent disease may present with metastases to the thoracoabdominal organs, lymph nodes, bones, skin and brain, for which systemic treatment represent the standard of care. Besides combined chemotherapy regimens, alternative chemotherapies, biosimilars and immune checkpoint inhibitors are now available, each associated with a definite pattern of response and toxicity. In this review, after describing the typical and atypical presentations of recurrent and advanced cervical carcinoma on cross-sectional imaging, we will discuss systemic treatment for recurrent or advanced disease and their associated radiographic sequelae, in light of the newly available therapies.

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Authors and Affiliations

  1. Department of Radiology, UH Cleveland Medical Center, Case Western Reserve University, 11100 Euclid Ave, Cleveland, OH, 44106, USA

    Colin Marshall, Maharshi A. Rajdev & Nikhil H. Ramaiya

  2. Department of Radiology, Harvard Medical School, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA

    Bhanusupriya Somarouthu

  3. Department of Imaging, Harvard Medical School, Dana Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA

    Francesco Alessandrino

  4. Department of Radiology, Harvard Medical School, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA, 02115, USA

    Francesco Alessandrino

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  1. Colin Marshall
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Marshall, C., Rajdev, M.A., Somarouthu, B. et al. Overview of systemic treatment in recurrent and advanced cervical cancer: a primer for radiologists. Abdom Radiol 44, 1506–1519 (2019). https://doi.org/10.1007/s00261-018-1797-4

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