In what scenario would you give consolidation chemotherapy after chemoradiation for stage 3 cervical cancer with a good response?

The current standard for stage IIIB cervical cancer is primary external beam radiation + concurrent cisplatin based chemotherapy + brachytherapy (see NCCN guidelines CERV6). Clearly, given the failure rate with distant metastases after primary therapy, there exists significant interest in adjuvant chemotherapy. Small studies of adjuvant therapy using older agents have shown no benefit. Newer studies of primary concurrent chemo-RT which included 2 cycles of cisplatin-containing post radiation chemotherapy (GOG109; Duenas-Gonzalez et al J Clin Oncol 2011) were promising. The Duenas-Gonzalez study showed a significant survival advantage for use of concurrent gemcitabine/cisplatin with 2 additional cycles following completion of radiation.

Howe...

We know these patients are at high risk of recurrence due to their advanced stage disease, though we do not have clear data to show the benefit of additional chemotherapy after chemoradiation.

Dueñas-González et al published a study to assess whether the addition of gemcitabine to concurrent cisplatin chemoradiotherapy and as adjuvant chemotherapy with cisplatin improves PFS at three years. Patients received cisplatin plus gemcitabine concurrent with radiation, followed by two additional cycles of cisplatin plus gemcitabine after completion of radiation, compared to standard cisplatin weekly concurrent with radiation. Those who received additional chemotherapy had an improvement in PFS and OS. There were more grade 3/4 AEs and more hospital...

There is limited level I evidence to support this. So technically the "standard" is to observe after upfront chemoradiation, but we have done this in women who seem to have possibly persistent disease... Not sure if this answers the question?