The treatment of stage IVB cervical cancer is undergoing a paradigm shift, moving beyond palliation toward strategies that may improve survival rates in select patients. Radiation therapy is a key component of this shift, not only for local control, but also for enhancing systemic treatment efficacy and improving survival time. Stereotactic body radiation therapy (SBRT) for oligometastatic disease and image-guided brachytherapy improve tumor control while minimizing toxicity. The incorporation of immune checkpoint inhibitors into frontline therapy represents a significant advancement, particularly for PD-L1-positive tumors. However, durable responses remain a challenge, necessitating continued research into novel biomarkers and combination therapies. Personalized treatment approaches, integrating molecular profiling and adaptive therapy strategies, are essential for optimizing outcomes. Future clinical trials should evaluate the synergy between radiation and immunotherapy in order to refine curative approaches in stage IVB cervical cancer.
