Radiotherapy Outcomes in Locally Advanced Carcinoma Cervix: A Comprehensive Multicenter Analysis of Survival, Toxicity, and Technological Evolution in the Era of Image-Guided Adaptive Radiotherapy and Immuno-Oncology

Abstract

Cervical cancer remains a major global oncological burden, particularly in low- and middle-income countries where patients commonly present with locally advanced disease requiring definitive radiotherapy-based management. This study evaluates radiotherapy outcomes in locally advanced carcinoma cervix (FIGO IB3–IVA) treated between 2020 and 2026 using modern external beam radiotherapy techniques, concurrent cisplatin-based chemotherapy, and image-guided adaptive brachytherapy (IGABT). The objective was to analyze survival outcomes, toxicity profiles, patterns of failure, and the clinical impact of technological advancements including intensity-modulated radiotherapy (IMRT), volumetric modulated arc therapy (VMAT), and MRI-guided brachytherapy. A multicenter retrospective cohort design was utilized, with survival outcomes assessed using Kaplan–Meier analysis and prognostic factors evaluated through multivariate Cox regression modeling. Treatment-related toxicities were graded according to CTCAE v5.0 criteria. The findings demonstrate that MRI-guided adaptive brachytherapy is the most significant determinant of locoregional control, achieving survival rates exceeding 70% and local control rates above 90% in optimally treated patients. Advanced external beam radiotherapy techniques significantly reduced acute and late toxicities but did not independently improve overall survival, indicating a plateau in radiotherapy-driven survival benefit. The dominant pattern of failure shifted toward distant metastasis, highlighting the systemic nature of disease progression in the modern treatment era. The study concludes that while radiotherapy remains the cornerstone of curative treatment for locally advanced cervical cancer, future survival improvements will depend on systemic therapeutic strategies, particularly immunotherapy integration and molecularly guided treatment approaches.