A 48-year-old woman presents with bulky Stage IIB cervical squamous cell carcinoma. She is treated with concurrent chemoradiation with cisplatin followed by intracavitary brachytherapy. After brachytherapy, the residual tumor is 1.5 cm. What is the recommended further management?
- A No further treatment; continue surveillance ✓
- B Adjuvant chemotherapy with carboplatin/paclitaxel
- C Extra-fascial hysterectomy
- D Additional external beam radiation boost to the cervix
Explanation
After definitive chemoradiation with brachytherapy for locally advanced cervical cancer, residual tumor up to 2 cm at the cervix is not an indication for adjuvant hysterectomy or additional treatment. The standard is to follow with clinical assessment and imaging (PET-CT at 3 months). Routine extra-fascial hysterectomy after chemoradiation is not recommended as it does not improve outcomes and adds morbidity. Adjuvant chemotherapy is not standard after definitive chemoradiation. Additional external beam radiation would exceed normal tissue tolerance. Surveillance with response assessment is appropriate.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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