Table 2.

Recommendations for postoperative RT with or without systemic therapy

KQ1 Recommendations	Strength of Recommendation	Quality of Evidence (Refs)
1. For women undergoing surgery for cervical cancer who have high surgicopathologic risk factors, adjuvant EBRT and concurrent platinum-based chemotherapy are recommended. Implementation remark: High-risk factors include positive margin(s) or positive lymph node(s) or extension into the parametrial tissue.	Strong	High 1−4
2. For women with cervical cancer and intermediate-risk factors, adjuvant EBRT is recommended to decrease locoregional recurrence. Implementation remark: Intermediate-risk factors include*: ● LVSI plus deep one-third cervical stromal invasion with any tumor size ● LVSI plus middle one-third stromal invasion and tumor size ≥2 cm ● LVSI plus superficial one-third stromal invasion and tumor size ≥5 cm ● No LVSI but deep or middle one-third stromal invasion plus tumor size ≥4 cm	Strong	High 5−7

Abbreviations: EBRT = external beam radiation therapy; LVSI = lymphovascular space involvement; RT Z radiation therapy.

^*The original Gynecologic Oncology Group (GOG) 92 protocol estimated tumor size based on palpation; however, estimation based on pathologic or magnetic resonance imaging findings are an acceptable substitute.