Introduction The combination of immune checkpoint inhibitors and chemotherapy, with or without bevacizumab, has demonstrated promising results in improving overall survival and is now part of the standard treatment after Keynote-826. Locally recurrent cervical cancer poses a challenge for treatment, particularly when the patient cannot receive radiotherapy due to fistula development. This video describes the use of pembrolizumab/bevacizumab with platinum-based chemotherapy (PBC) followed by organ-preserving surgery.

Description A 31-year-old patient visited with locally recurrent cervical cancer after four years after undergoing radical trachelectomy for FIGO stage IB1 disease. The 4 cm tumor at the cervix showed invasion into the posterior bladder wall with multiple lymph node enlargements. The patient was not eligible for radiotherapy due to fistula development and was treated with a combination of PBC for six cycles followed by surgery. After systemic treatment, the tumor reduced to 1.5 cm, and lymph nodes decreased in size. During laparotomy, tumor invasion was found in the right pelvic sidewall and bladder. Type D1 radical hysterectomy was performed on the right side, and type B1 radical parametrectomy was performed on the left side. A 1 cm vesicovaginal fistula was found at the left ureter entrance, and partial cystectomy with bladder repair and right ureteroneocystostomy, along with systematic pelvic and para-aortic lymphadenectomy, was performed to achieve R0.

Conclusion/Implications PBC can be used to treat locally recurrent cervical cancer. This therapy followed by surgery allows for the preservation of pelvic organs with R0 resection, and the patient can continue with pembrolizumab maintenance.