A postmenopausal woman with Stage IVA cervical carcinoma (bladder invasion) presents with unilateral ureteral obstruction and hydronephrosis. She is otherwise fit. What is the primary treatment modality?

• A Pelvic exenteration
• B Concurrent chemoradiation (cisplatin-based) ✓
• C Systemic chemotherapy alone (carboplatin-paclitaxel)
• D Palliative radiation only

Explanation

FIGO Stage IVA (bladder or rectal mucosal invasion without distant metastasis) is treated with definitive concurrent chemoradiation — cisplatin 40 mg/m² weekly with external beam radiotherapy followed by brachytherapy. Pelvic exenteration is reserved for central recurrence after prior chemoradiation, not primary treatment of IVA. Chemotherapy alone does not provide adequate locoregional control. Palliative radiation alone is inferior to chemoradiation.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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