A 35-year-old woman has Stage IB2 cervical cancer (tumor 5.5 cm, confined to cervix on imaging). Which is the recommended primary treatment according to current guidelines?
- A Concurrent chemoradiation (cisplatin + external beam radiotherapy + brachytherapy) ✓
- B Radical hysterectomy with pelvic lymph node dissection
- C Neoadjuvant chemotherapy followed by radical hysterectomy
- D Simple hysterectomy followed by adjuvant radiotherapy
Correct answer: A. Concurrent chemoradiation (cisplatin + external beam radiotherapy + brachytherapy)
Explanation
For locally advanced cervical cancer including FIGO 2018 Stage IB3 (≥4 cm), concurrent chemoradiation is the standard primary treatment. Stage IB2 (4–5 cm) in FIGO 2018 overlaps with what was called IB2 previously. For bulky Stage IB2/IB3 tumors, the Sedlis criteria and GOG studies show concurrent cisplatin-based chemoradiation with brachytherapy achieves equivalent or better outcomes with less morbidity than surgery. Surgery is preferred for Stage IB1 (< 4 cm).
Reference: Shaw's Textbook of Gynaecology, 17th ed.
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