A 34-year-old woman underwent radical hysterectomy with pelvic lymphadenectomy for Stage IB1 squamous cell carcinoma of the cervix. Final pathology shows: tumor 2.8 cm, deep stromal invasion >50%, lymphovascular space invasion present, negative nodes, and negative margins. Which adjuvant treatment is indicated based on the Sedlis criteria?

• A Adjuvant concurrent chemoradiation
• B No adjuvant treatment; surveillance only
• C Adjuvant chemotherapy alone (carboplatin/paclitaxel)
• D Adjuvant external beam radiation alone ✓

Explanation

The Sedlis criteria identify intermediate-risk factors for recurrence after radical hysterectomy: tumor size >2 cm, deep stromal invasion (>1/3), and LVSI. This patient has all three, qualifying for adjuvant pelvic external beam radiation. The GOG 92 trial showed adjuvant radiation reduced recurrence in this intermediate-risk group. Adjuvant chemoradiation (GOG 109/Sedlis upgrade) is reserved for high-risk features: positive nodes, positive margins, or parametrial involvement. Chemotherapy alone is not standard adjuvant therapy in this setting.

Reference: Bailey and Love's Short Practice of Surgery, 28th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.