A 46-year-old woman developed an isolated central pelvic recurrence of cervical squamous cell carcinoma 18 months after radical hysterectomy and adjuvant chemoradiotherapy. PET-CT shows no extrapelvic disease and the rectum and bladder are uninvolved. She is fit for major surgery. The treatment offering the best chance of long-term survival is:

• A Repeat course of concurrent chemoradiotherapy
• B Bevacizumab with carboplatin and paclitaxel
• C High-dose-rate intracavitary brachytherapy alone
• D Total pelvic exenteration with urinary and faecal diversion ✓

Explanation

For a surgically resectable central pelvic recurrence after prior radiotherapy, pelvic exenteration provides 5-year survival rates of roughly 30 to 60 percent and is the only potentially curative option, since further radiotherapy is limited by tissue tolerance. Systemic chemotherapy with bevacizumab (GOG 240 setting) is palliative and reserved for unresectable or metastatic disease. Brachytherapy alone is inadequate after previous external beam treatment and cannot encompass a post-hysterectomy central recurrence reliably.

Reference: Berek and Novak's Gynecology, 16th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.