A 55-year-old woman develops a biopsy-proven isolated central pelvic recurrence of squamous cervical cancer 2 years after radical hysterectomy and adjuvant radiotherapy. Examination and PET-CT show a 3 cm vesicovaginal septum mass, no hydronephrosis, no nodal or distant disease, and a functioning rectovaginal septum free of tumour. Which statement about her management is correct?

• A She is unsuitable for surgery because prior radiotherapy precludes further pelvic surgery
• B Weekly cisplatin alone provides equivalent survival to exenteration in this setting
• C Repeat external beam radiotherapy to the same field is the preferred curative option
• D Pelvic exenteration offers her the best chance of cure if resection margins can be clear ✓

Explanation

Isolated central pelvic recurrence after primary surgery, in a patient who has not received prior radiotherapy to that volume or who can tolerate it, is the classic indication for pelvic exenteration, the only potentially curative option, provided disease is resectable with clear margins and there is no hydronephrosis or extrapelvic spread. Prior radiotherapy actually favours exenteration over re-irradiation, which risks severe bowel injury. Chemotherapy alone is palliative here.

Reference: Berek and Novak's Gynecology, 16th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.