Radiation therapy and concurrent cisplatin-based chemotherapy is the most appropriate treatment for this patient who has bulky stage III cervical cancer (extending to the pelvic wall and/or involving the lower third of the vagina). Cervical cancer remains the second most common cancer in women worldwide. Early-stage cervical cancer without spread to the pelvic wall or to the lower third of the vagina can be treated successfully with surgery alone, but more locally advanced cancer requires radiation therapy instead of surgery. In 1999, based on five published randomized clinical trials, the National Cancer Institute issued a clinical alert recommending chemoradiation therapy for locally advanced cervical cancer. These initial studies used cisplatin-based chemotherapy during radiation; results showed a decrease in local and distant recurrence compared with radiation therapy alone.

Chemoradiation has since become the standard of care, and weekly cisplatin administration during radiation is the most frequently used regimen, although non–platinum-based chemotherapy regimens also have been shown to be effective. Radiation therapy alone can be used for patients with stage I (confined to the cervix) or nonbulky stage II cervical cancer (invading beyond the uterus but not to the pelvic wall or lower third of the vagina) as an alternative to hysterectomy but should be combined with chemotherapy for patients with bulky stage II, stage III, and stage IVA cervical cancers (spread to adjacent organs but no distant metastases).

Radical hysterectomy is appropriate for patients with stage I or nonbulky stage IIA cervical cancer, which includes invasion beyond the uterus but not extending to the pelvic wall or to the lower third of the vagina. However, radical hysterectomy is not an option for this patient who has bulky disease extending to the pelvic wall (stage III).

There is no benefit to using adjuvant chemotherapy after hysterectomy or to administering chemotherapy prior to surgery. The survival benefit of chemotherapy is proven only when given with concomitant radiation therapy for patients with intermediate- and high-risk cervical cancer.

Patients with stage I cervical cancer may have ovarian preservation if maintaining fertility is desired. For microscopic disease confined to the cervix (stage IA), simple hysterectomy, cone biopsy, or removal of the cervix alone are options, all of which include ovarian preservation.