A 39-year-old woman undergoes radical hysterectomy with pelvic lymphadenectomy for a 3 cm cervical squamous cell carcinoma. Histopathology reveals metastatic squamous carcinoma in two right obturator lymph nodes; margins are free and there is no parametrial invasion. What is the most appropriate adjuvant treatment?

• A Observation with close follow-up
• B Vaginal brachytherapy alone
• C Six cycles of carboplatin and paclitaxel chemotherapy alone
• D Concurrent cisplatin-based chemoradiotherapy ✓

Explanation

Positive pelvic nodes constitute a high-risk feature mandating adjuvant concurrent cisplatin-based chemoradiation following radical hysterectomy, based on evidence showing improved survival over radiotherapy alone. Observation is unacceptable with nodal disease, brachytherapy alone treats only the vault, and chemotherapy alone is not the standard adjuvant approach in this setting. Positive margins and microscopic parametrial invasion are the other two high-risk indications alongside nodal metastasis.

Reference: Berek and Hacker's Gynecologic Oncology, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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