A 38-year-old woman is diagnosed with Stage IB2 cervical squamous cell carcinoma (4.5 cm tumor, no parametrial extension, no lymph nodes on PET-CT). She has completed her family. The most appropriate treatment according to current ESGO/NCCN guidelines is:

• A Radical hysterectomy (Wertheim-Schauta) + pelvic lymphadenectomy, possibly followed by adjuvant therapy
• B Neoadjuvant chemotherapy followed by radical hysterectomy
• C Simple hysterectomy with sentinel lymph node biopsy
• D Concurrent chemoradiation (cisplatin-based) as primary treatment ✓

Explanation

For Stage IB2 cervical cancer (4.1-5 cm per FIGO 2018), both radical hysterectomy and concurrent chemoradiation are acceptable, but current evidence (LACC trial, 2018) supports concurrent chemoradiation as the preferred primary treatment for tumors >4 cm due to equivalent or superior survival with lower morbidity compared to surgery. The LACC trial also showed worse recurrence-free survival with minimally invasive radical hysterectomy vs open surgery. Concurrent cisplatin-based chemoradiation remains the standard for locally advanced disease. Neoadjuvant chemotherapy followed by surgery is not routinely recommended outside trials.

Reference: Shaw's Textbook of Gynaecology, 17th ed.

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Written and medically reviewed by the StethoPrep medical team.