Giuseppe Caruso, Medical Consultant at IEO Istituto Europeo di Oncologia, shared on LinkedIn:
“Pelvic exenteration for locally recurrent or persistent cervical cancer in the modern era: still an option, but no longer the first one?
I’m delighted to share that our international expert consensus on the contemporary role of pelvic exenteration in recurrent or persistent cervical cancer is now online in the International Journal of Gynecological Cancer (IJGC).
This paper started in a room at IEO (IEO Istituto Europeo di Oncologia).
In October 2025, we gathered gynecologic oncologists, medical and radiation oncologists, general, urologic and plastic surgeons, radiologists, and psycho-oncologists to discuss one question: where does pelvic exenteration fit today, now that immunotherapy and modern re-irradiation have changed the landscape, with many more options (eg, ADCs) to come? We then turned those discussions into a two-round modified Delphi survey among 15 experts from 15 centers in 5 countries.
A heartfelt thank you to Dr. Angelo Maggioni for conceiving and organising that meeting, and for insisting that this question deserved a real answer rather than a reflex.
Key messages:
- Multidisciplinary, always. Patients with local relapse after prior RT should be referred early to high-volume centers with dedicated MDTs.
- Personalised selection. Histology, grade, LVSI, age, and BMI alone should not automatically exclude a patient from pelvic exenteration. Performance status, frailty, and psychosocial support matter.
- Immunotherapy first? In immunotherapy-naïve patients (PD-L1–positive, CPS ≥1), modern systemic therapy should be considered and discussed before pelvic exenteration, with early reassessment so the curative surgical window is not missed.
The newly published ESMO cervical cancer guidelines also recommend pelvic exenteration or re-irradiation (when feasible) for local relapse. Our survey probably adds a step before either: if a patient has not yet received immunotherapy, that question should probably come first.
From these discussions, we developed a step-by-step algorithm to guide patient selection and treatment sequencing, which you can find below.”
Title: International expert consensus on the contemporary role of pelvic exenteration in recurrent or persistent cervical cancer
Authors: Giuseppe Caruso, Filippo Casaccia Giordano, Vanna Zanagnolo, Alessia Aloisi, Nadeem R. Abu-Rustum, Roberto Angioli, Vito Chiantera, Luis Chiva, David Cibula, Anna Fagotti, Christina Fotopoulou, Angiolo Gadducci, Amanika Kumar, Fabio Landoni, Francesco Raspagliesi, Paolo Scollo, Roberto Tozzi, Giuseppe Vizzielli, Francesco Multinu, Giovanni Aletti, Angelo Maggioni
Read the Full Article.
