14
Treatment
Table 4. Recommendations for Stage IIB, III, IVA, and IVB
and Recurrent Disease
Type of Disease Basic Limited
IIB and IIIA NACT followed by
extrafascial hysterectomy
(modification as deemed
necessary)
(CB, In, W)
Extrafascial hysterectomy
when chemotherapy is not
consistently available
(CB, In, W)
Palliative care
(CB, I, S)
ChemoRT or RT
a
followed
extrafascial or modified
hysterectomy ± PLND
b
± PANB
NACT followed by extrafascial or
modified hysterectomy ± PLND
b
± PANB
(CB, L-I, W-M)
Extrafascial or modified
hysterectomy plus pelvic LND
± para-aortic LN sampling
c
plus
adjuvant therapy
(CB, In, W)
IIIB to IVA Palliative care
(EB, I, S)
NACT followed by
extrafascial hysterectomy
(CB, In, W)
ChemoRT or RT
a
followed
by extrafascial or radical
hysterectomy (see Note) ± PLND
b
± PANB
NACT (followed by radical
hysterectomy plus PLND
b
±
PANB may be an option)
and/or palliative care
(CB, L-I, W-M)
RT ± concurrent low-dose
platinum-based chemotherapy
(may offer systemic adjuvant
chemotherapy)
(EB, I, M)
Note Wherever radical hysterectomy
with concurrent chemoRT
listed as a surgical option above,
extrafascial hysterectomy is
preferred if there is residual
disease or initial tumor >6 cm
(CB, I, W)
IVB Palliative care and
chemotherapy (if available)
(EB, H, S)
Palliative care and/or chemotherapy
± individualized RT (palliative care
may include palliative RT)
(EB, H, S)
