Background: For over two decades, concurrent chemoradiation (CRT) has been the cornerstone of treatment for locally advanced cervical cancer (LACC). However, survival outcomes have stagnated, with distant metastasis now the primary mode of failure and CRT imposes a significant burden of permanent toxicity that impairs long-term quality of life. Objective: This review critically appraises the evidence for CRT and evaluates the modern role of surgery in the management of LACC. Methods: A narrative review was conducted, synthesizing evidence from pivotal randomized trials, contemporary retrospective cohorts, meta-analyses, and major societal guidelines. Findings: While CRT remains a cornerstone, its universal application is being questioned due to toxicities and survival plateaus. For selected patients with early LACC (FIGO IB3/IIA2), modern radical hysterectomy offers a valid alternative, providing a superior long-term quality-of-life profile by avoiding radiation sequelae, but only if adjuvant radiotherapy can be avoided. Furthermore, the integration of immunotherapy is reshaping the therapeutic landscape for both modalities. Conclusion: The management of LACC is evolving beyond a universal CRT paradigm towards a personalized approach. Primary surgery is a compelling option for a well-selected subset, aiming to optimize quality of life without compromising survival. The future lies in prospective trials that integrate modern surgery and novel systemic therapies to definitively guide patient-specific treatment choices and validate personalized paradigms.