A 35-year-old woman with stage IB2 cervical squamous cell carcinoma (4.5 cm tumor) has completed concurrent chemoradiation with cisplatin. Follow-up PET-CT at 3 months shows a metabolically active residual cervical mass. What is the most appropriate next step?

• A Repeat PET-CT at 6 months — early response assessment may be falsely positive due to inflammation
• B Proceed directly to pelvic exenteration as the only curative option for CRT failure
• C Biopsy the residual mass to confirm viable tumor before planning salvage surgery ✓
• D Start second-line chemotherapy with carboplatin-paclitaxel-bevacizumab for recurrent disease

Explanation

Post-chemoradiation imaging changes (inflammation, fibrosis) can mimic residual tumor; biopsy is necessary to confirm viable malignancy before committing to major salvage surgery. A PET-CT 3 months post-CRT showing metabolic activity does not exclude inflammatory change. Once viable residual or recurrent central disease is confirmed histologically, pelvic exenteration is the only potentially curative option. Systemic chemotherapy (with bevacizumab, per GOG 240) is for metastatic/non-operable disease.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.