A 42-year-old woman is diagnosed with FIGO 2018 Stage IB3 cervical squamous cell carcinoma (tumor >4 cm, confined to cervix). According to current NCCN/ESMO guidelines, the preferred primary treatment is:

• A Radical hysterectomy (Wertheim's) with bilateral pelvic lymph node dissection
• B Concurrent cisplatin-based chemoradiation (external beam radiotherapy + brachytherapy) ✓
• C Neoadjuvant chemotherapy (NACT) followed by radical hysterectomy to improve operability
• D Primary exenteration for best local control in large volume disease

Explanation

FIGO 2018 Stage IB3 (tumor >4 cm confined to cervix) is best managed with concurrent cisplatin-based chemoradiation (weekly cisplatin 40 mg/m² with EBRT + intracavitary brachytherapy). Multiple randomized trials (GOG 120, RTOG 90-01) have shown concurrent chemoradiation achieves superior disease-free and overall survival compared to either surgery or radiation alone for bulky stage IB disease. Radical hysterectomy (A) is appropriate for Stage IB1 and IB2. NACT followed by surgery (C) has not shown superiority over chemoradiation in randomized trials (EORTC 55994). Primary exenteration (D) is reserved for central recurrence, not primary treatment.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.