A 58-year-old woman develops biopsy-proven recurrent squamous cell carcinoma confined centrally to the cervix and upper vagina three years after completing definitive chemoradiation for Stage IIB disease. PET-CT shows no nodal or distant disease, and she is medically fit. Which intervention offers her the best chance of long-term survival?
- A Repeat course of external beam radiotherapy with brachytherapy boost
- B Bevacizumab with paclitaxel and cisplatin
- C Total pelvic exenteration ✓
- D Radical hysterectomy with bilateral salpingo-oophorectomy
Correct answer: C. Total pelvic exenteration
Explanation
Central pelvic recurrence after prior full-dose radiotherapy cannot be re-irradiated safely, and radical hysterectomy is technically impossible after radiation changes. Total pelvic exenteration with urinary and faecal diversion is the only potentially curative option for centrally recurrent disease without nodal or distant spread, offering five-year survival around 40 to 60 percent in selected fit patients. Systemic chemotherapy is palliative in this setting.
Reference: Novak's Gynecology, 16th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.