Treatment of Central Pelvic Recurrence of Cervical Cancer Without Sidewall or Peritoneal Involvement, in Radiotherapy-Naive Patients
This protocol defines the recommended management for cervical cancer presenting as a central pelvic recurrence, specifically where the pelvic sidewall is not involved, there is no spread to extra-pelvic lymph nodes, and there is no peritoneal disease — in patients who have not previously received radiotherapy.
Clinical Scenario
- Central pelvic recurrence of cervical cancer
- No pelvic sidewall involvement
- No extra-pelvic nodal disease
- No peritoneal disease
- Radiotherapy naive
Treatment Approach
In radiotherapy-naive patients meeting these criteria, definitive chemoradiotherapy is the preferred approach. Where radiation therapy is not available or feasible, an alternative surgical strategy directed at the central pelvis may be considered under specific conditions — including the ability to achieve complete tumor clearance.
The full criteria, preferred sequence, and surgical requirements are available in the complete structured protocol below.
References
DOI: 10.1016/j.ijgc.2025.102747
- Pelvic exenteration is recommended for central pelvic recurrence where there is no involvement of the pelvic sidewall, extra-pelvic nodes, or peritoneal disease.
- Definitive chemoradiotherapy combined with image-guided adaptive brachytherapy is the treatment of choice in radiotherapy naïve patients.
- Pelvic exenteration should be considered if a complete surgical removal of a tumor, R0 resection, can be achieved, and perioperative management as well as long-term support can be offered.
- When radical radiotherapy is not feasible, extended pelvic surgery can be considered. Surgery must aim for a complete tumor resection (R = 0), also with the help of special techniques (laterally extended endopelvic resection), if required.
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