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

  • Colin Marshall
  • Maharshi A. Rajdev
  • Bhanusupriya Somarouthu
  • Nikhil H. Ramaiya
  • Francesco AlessandrinoEmail author
Pictorial essay


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.


Uterine cervical neoplasms Neoplasm recurrence Neoplasm metastases Diagnostic imaging Antineoplastic agents Biosimilar pharmaceuticals 


Compliance with ethical standards


No funding was received for this study.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

Statement of informed consent is not applicable since the manuscript does not contain any patient data.


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Authors and Affiliations

  1. 1.Department of Radiology, UH Cleveland Medical CenterCase Western Reserve UniversityClevelandUSA
  2. 2.Department of Radiology, Harvard Medical SchoolMassachusetts General HospitalBostonUSA
  3. 3.Department of Imaging, Harvard Medical SchoolDana Farber Cancer InstituteBostonUSA
  4. 4.Department of Radiology, Harvard Medical SchoolBrigham and Women’s HospitalBostonUSA

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