When would you consider sequential chemotherapy and radiation rather than concurrent for early stage cervical cancer with high risk pathologic features?

How much of the results of the STARS (Huang et al., PMID 33443541) (showing improved DFS with SCRT compared to CCRT) driven by only a 62% completion rate of CCRT (compared to 73.4% in SCRT, p< 0.001) as per the specified protocol is unknown.

While the authors state within their results section that the per-protocol analysis showed statistical superiority of SCRT, that is true only for the comparison to RT alone, as per Figure 2C within the paper.

I have not seen a combination Cis/Taxol delivered in the US - more common is CarboTaxol, which as per a previously referenced trial within the introduction of STARS, did not show any statistical benefit to sequential use of CarboTaxol + RT vs CRT w/ cisplatin (Sehouli et al., PMID 22357252).

There are...

A critical review of this paper is not appropriate in this forum. Yes, I would consider it. No, I don't believe that this paper creates a new standard of care at this point. The differences in OS are very small, and the overall compliance with the SCRT arm is still less than 75% (drop out rate mostly due to chemotherapy toxicity). I would say that it is an option, especially in the very high risk population with positive LN's.