Would you offer any adjuvant therapy for cervical cancer following total pelvic exenteration in the setting of a positive pelvic lymph node?

I am going to "eat a bit of crow" here and admit to having been schooled a bit by the esteemed Dr. @Dr. First Last. I admit to having immediately jumped to the post-rad hyst situation rather than post-exenteration, and I agree that the radicality of the operation could factor into the decision about post-op RT in this situation. However, I would just suggest that the answer to the original question is probably more nuanced, and probably does not merit a "yes-RT" or "no-RT" answer. As always, one will need to balance risk and benefit and make the best decision possible in the absence of solid data (as Dr. Creasman confirms). I do think that in many cases it would be possible to give adjuvant RT safely, even after exenteration. I will also su...

A study several decades old noted that with one positive node at time of exent, those patients did just as well as if negative nodes would follow.

I have to respectfully disagree with Dr. @Dr. First Last. The very old study that he refers to was certainly not powered to answer this question, as it was simply a subset analysis with small numbers. In subsequent studies by the GOG, patients with single positive pelvic nodes were eligible for studies in which adjuvant pelvic RT was the standard treatment, e.g. GOG 109, Peters et al. In my opinion, adjuvant chemo-RT is the standard of care treatment and would be recommended in the vast majority of patients with a single positive pelvic LN. If the patient has a poor performance status, one might consider following, OR simply dropping the chemo and just giving pelvic RT. It is much easier and safer to prevent the recurrence than it is to sal...