A 55-year-old woman who received definitive chemoradiation for Stage IIB cervical cancer 2 years ago presents with persistent pelvic pain. PET-CT shows a 4 cm mass centred on the cervix invading the bladder base and anterior rectal wall, with no nodal or distant disease. Biopsy confirms recurrent squamous cell carcinoma. What is the most appropriate management?
- A Repeat external beam radiotherapy with concurrent cisplatin
- B Palliative single-agent carboplatin
- C Total pelvic exenteration ✓
- D High-dose-rate intracavitary brachytherapy alone
Correct answer: C. Total pelvic exenteration
Explanation
Central pelvic recurrence after prior full-dose radiotherapy, confined to the pelvis and resectable, is the classic indication for total pelvic exenteration with urinary and faecal diversion, offering the only realistic chance of cure. Re-irradiation risks severe bowel and bladder toxicity and is not standard. Palliative chemotherapy is reserved for unresectable or disseminated disease, and brachytherapy alone cannot encompass a large recurrent mass after previous irradiation.
Reference: Berek and Novak's Gynecology, 16th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.