A 48-year-old woman with Stage IIB cervical cancer completes concurrent chemoradiation with cisplatin. At 3-month follow-up, PET-CT shows a residual 1.5 cm hypermetabolic focus in the cervix with no parametrial extension or distant disease. Which is the most appropriate next step?
- A Immediate adjuvant hysterectomy
- B Observation with repeat imaging in 2-3 months to distinguish residual tumor from post-radiation inflammation ✓
- C Salvage chemoradiation with re-irradiation
- D Systemic chemotherapy with carboplatin and paclitaxel
Correct answer: B. Observation with repeat imaging in 2-3 months to distinguish residual tumor from post-radiation inflammation
Explanation
Post-treatment PET-CT at 3 months can show false-positive FDG uptake due to radiation-induced inflammation. Current guidelines recommend waiting 2-3 months before concluding residual disease. Adjuvant hysterectomy after chemoradiation does not improve outcomes and increases morbidity. Re-irradiation carries high toxicity. Systemic therapy is reserved for confirmed recurrence or metastatic disease.
Reference: NCCN Guidelines: Cervical Cancer
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Written and medically reviewed by the StethoPrep medical team.