Following radical hysterectomy with pelvic lymphadenectomy for Stage IB1 cervical cancer, final histopathology shows a 3.2 cm tumour with deep stromal invasion, lymphovascular space invasion, and one positive right obturator lymph node with negative margins. What is the appropriate adjuvant therapy?
- A Concurrent weekly cisplatin with pelvic external beam radiotherapy ✓
- B Vaginal brachytherapy alone
- C Observation with close surveillance
- D Six cycles of paclitaxel and carboplatin alone
Correct answer: A. Concurrent weekly cisplatin with pelvic external beam radiotherapy
Explanation
Positive lymph nodes, positive resection margins and microscopic parametrial involvement are high-risk features that mandate adjuvant concurrent chemoradiation, based on evidence that adding cisplatin to pelvic radiotherapy improves survival in this setting. Sedlis criteria apply to intermediate-risk patients with node-negative disease, so observation or brachytherapy alone would undertreat nodal metastasis, and chemotherapy alone is not established as adjuvant therapy.
Reference: Williams Gynecology, 4th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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