What are your next steps in management for a patient with endocervical adenocarcinoma s/p radical trachelectomy with a positive pelvic lymph node noted on final pathology?

With any surgically resected cervical cancer (whether nodal assessment followed a traditional approach/radical hysterectomy or nodal assessment followed by a fertility sparing approach/radical trachelectomy), when there are positive nodes on final pathology, our tumor board recommends following Peters criteria (PMID: 10764420). That means anyone with positive nodes and/or positive margins and/or positive parametria, the recommendation is to proceed with definitive dosing of chemoradiation. Unfortunately, this does mean when an initial fertility sparing approach was done that the final treatment will no longer be fertility sparing. Fortunately, with the uterine body remaining in the patient, it can be easier to get brachytherapy after their ...