How do you manage grade 1-3A Follicle Center Lymphoma of the lower female genital tract, presenting with a cervical mass?

I would treat this with 12 x 2 Gy.

Indeed, fertility preservation will be an issue here.

Depending on the size of the lesion, if the ovaries can be spared, then 24 Gy delivered to the cervix/uterus may still allow for a pregnancy with a favorable outcome.

Another experimental approach, if the patient is planning to have one child in the immediate future, may be to treat with 2 x 2 Gy or even considered rituximab monotherapy, and upon achieving remission, attempt for her to conceive.

Then, the lymphoma can be treated with full dose upon local recurrence or following the birth of the child. The risk however here is, that the lymphoma may recur during pregnancy.