Gynaecology: Locally advanced cervix — definitive chemoradiotherapy
Free question published 25 July 2026
A 52-year-old woman presents with intermenstrual bleeding. Examination and biopsy confirm a squamous cell carcinoma of the cervix. Pelvic MRI shows a 5.5 cm cervical tumour with right parametrial extension not reaching the pelvic side wall, and a 12 mm right external iliac node. There is no para-aortic nodal disease and no distant metastasis. Renal function is normal. Following multidisciplinary discussion, what is the most appropriate definitive treatment?
- AExternal beam radiotherapy with concurrent weekly cisplatin, followed by image-guided brachytherapy
- BRadical hysterectomy with bilateral pelvic lymphadenectomy
- CNeoadjuvant carboplatin and paclitaxel followed by radical surgery
- DExternal beam radiotherapy with concurrent cisplatin, without brachytherapy
- EExternal beam radiotherapy alone with an external photon boost to the cervix
Why A is correct
This is locally advanced (FIGO 2018 stage IIIC1 — parametrial involvement plus a pelvic node) cervical cancer. The ESGO/ESTRO/ESP 2023 guideline advises that definitive radiotherapy should include concomitant chemotherapy whenever possible (weekly cisplatin as standard), and that image-guided brachytherapy is an essential component that must not be replaced by an external boost. This was established by the 1999 concurrent chemoradiotherapy trials such as Morris et al.
And why the others are not
- BIncorrect. The guideline advises avoiding combining radical surgery and radiotherapy because of the high morbidity, and bulky node-positive parametrial disease is treated with definitive chemoradiotherapy, not primary surgery.
- CIncorrect. Neoadjuvant chemotherapy followed by surgery is not the standard pathway; definitive chemoradiotherapy with brachytherapy is recommended.
- DIncorrect. Omitting brachytherapy is substandard; image-guided brachytherapy is an essential component of definitive radiotherapy.
- EIncorrect. The guideline explicitly states image-guided brachytherapy should not be replaced with an external boost, and radiotherapy alone is inferior to chemoradiotherapy.
Source ESGO/ESTRO/ESP Guidelines for the management of patients with cervical cancer — Update 2023 — Cibula D, Raspollini MR, Planchamp F, et al. ESGO/ESTRO/ESP Guidelines for the management of patients with cervical cancer — Update 2023. International Journal of Gynecological Cancer / Radiotherapy and Oncology, 2023.
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