A 36-year-old woman underwent radical hysterectomy with pelvic lymphadenectomy for a 3 cm squamous cell carcinoma of the cervix. Histopathology reveals two right obturator lymph nodes positive for metastatic squamous cell carcinoma; margins and parametria are free. What is the most appropriate adjuvant management?
- A Concurrent weekly cisplatin with pelvic external beam radiotherapy ✓
- B Vaginal vault brachytherapy alone
- C Observation with serial SCC antigen monitoring
- D Six cycles of paclitaxel and carboplatin alone
Correct answer: A. Concurrent weekly cisplatin with pelvic external beam radiotherapy
Explanation
Positive pelvic lymph nodes after radical hysterectomy are a high-risk feature mandating adjuvant concurrent chemoradiation, established by the GOG 109 trial, which showed improved survival with cisplatin-based chemoradiation over radiotherapy alone. Observation is inadequate because nodal positivity predicts pelvic failure. Chemotherapy alone is not a standard adjuvant strategy in this setting, and brachytherapy alone does not address nodal disease.
Reference: Novak's Gynecology, 16th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.