How would you approach treatment for centrally recurrent cervical SCC with positive margins after excision that was not exenteration?

We treat with concurrent chemo RT with EBRT plus brachy.

Total dose of brachy is based on the extent to residual disease.

For positive margin as above with non oncological resection, 65-70 Gy equivalent dose.

Would get MRI of pelvis with vaginal gel to assess any residual disease.

We would treat this with concurrent chemotherapy and external beam radiotherapy and radiation oncology would most likely include brachytherapy as well (as this patient has had no prior chemo or radiation therapy).

Good that PET CT was done to assess for distant disease as well.

When we reviewed locally recurrent cervical cancer, about 50 cases at M.D Anderson many many years ago (published 1997), the best prognosis were those patients with central disease (vs sidewall), SCC (vs adeno), and long disease free interval. Agree with external beam + brachy.