Modern approaches to combined treatment of patients with locally advanced cervical cancer: neoadjuvant chemotherapy and nerve-sparing surgery

A systematic analysis of contemporary literature was conducted to review the use of nerve-sparing radical hysterectomy (NSRH) in the combined treatment of locally advanced cervical cancer (LACC). Over the past decades, new treatment approaches have been actively explored, combining neoadjuvant chemotherapy (including intra-arterial selective cytostatic infusion) with subsequent radical surgical procedures. The use of neoadjuvant chemotherapy enables significant tumor regression and increases operability, thereby creating favorable conditions for performing complex nerve-sparing surgeries. However, to date, there are no comprehensive studies investigating NSRH after neoadjuvant chemotherapy, nor the functional and long-term outcomes of this technique. The few available clinical studies are heterogeneous and limited by small sample sizes, which precludes statistical analysis and the development of standardized recommendations for the use of this approach in the management of locally advanced cervical cancer. One of the promising directions for optimizing treatment outcomes in LACC is the integration of intra-arterial selective chemo-infusion with advanced nerve-sparing surgical techniques, aimed at maximizing quality of life while maintaining oncologic radicality.