Introduction/Background A 24-year-old patient, G4P4 was referred to oncology with squamous cell carcinoma of the cervix. The patient was diagnosed during pregnancy at 32 weeks and delivered at 37 weeks by caesarean section then continued with lymphadeno-colpo-hysterectomy and lombo aortic lymphadenectomy (Wertheim). Histopathology report described nonkeratinizing squamous cell carcinoma G3 pT1b2 pN1(1/39) FIGO stage IB2 confirmed by immunohistochemistry with p16 positive, p63 positive, ER negative, Ki67 60- 65% features.
Methodology PET-CT was performed and pelvic recurrence with bilateral iliac internal and external lymph nodes and inferior lombo-aortic lymph nodes FGD-avid were found. The case was discussed in MDT and chemoradiation was commenced. She received EBRT by VMAT 45Gy in 25 fractions over pelvis recurrence, postoperative bed and elective lymph nodes followed by boost up to 55 Gy SIB on tumour lymph nodes, concurrent with Cisplatin 40 mg/m2 q1w. EBRT was followed by two sessions of brachytherapy 3D D90 HR CTV 6.5/Gy/day, one day apart. Therapy well-tolerated, with G1 toxicities and completed in November 2020.
Results Pacient was followed every three months with CT thorax and MRI abdomen and pelvis, both with contrast. In December 2021 PET-CT showed psoas, iliacus muscles and peritoneal recurrence. Case was discussed in MDT and Bevacizumab/Paclitaxel/Carboplatin q3w was commenced. After 4 cycles partial response was noted and pacient was referred to surgery for salvage pelvic exenteration. Surgical consultation recommended four more cycles and imaging. At the moment the patient is awaiting PET-CT.
Conclusion MDT has been shown in the carepath of cancer patient to significantly prolong overall survival and reduce discrepancies in cancer management. Our treatment has been guided by the surgical approach and therefore awaiting dynamic imaging tests to address and improve odds. Longer follow up will allow us to assess the impact on median overall survival and QoL.
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