Table 5.

Management of local recurrences. Image-guided adaptive brachytherapy (IGABT); intra-operative radiotherapy (IORT); CTRT: chemio-radiotherapy; PE: pelvic exenteration; BT: brachytherapy; pt: patients. EBRT: external beam radiation therapy; R: recurrence; TA: thermal ablation, S-RT: stereotactic RT; RA: radiofrequency ablation.

	ESGO	NCCN	ASCO	AIOM	FIGO	BGCS	SEOM	ESMO	JSGO
Central pelvic relapse after surgery	CTRT + IGABT.	Surgery or EBRT +/− CHT.	CHT-RT or RT +/− BT. (maximal setting).	CHT-RT + BT.	PE (if pelvic wall and extrapelvic nodes are negative).	CT-RT or PE.	CRT +/− IMRT, BT.	RT +/− BT.	RT or CT-RT if localized, single to few lesions.
Pelvic sidewall relapse after surgery	RT if patient naive; extended pelvic surgery (LEER).	EBRT and/or CHT; resection +/− IORT or CHT.	CHT, tumor-directed RT, and palliative care.	CHT-RT.	CT-RT or PE.	Non-repeat previous therapy principle.	CRT +/− IMRT, BT.	-	-
Central pelvic or sidewall after RT	PE if central; if lateral, surgery in high experienced centers. CHT in non-suitable pt PE + IORT (Central); in <2 cm lesions, RH or BT.	PE + IORT (Central); in <2 cm lesions, RH or BT.	PE if central (enhanced setting); CHT, tumor-directed RT for pelvic sidewall. In maximal setting, Prior RT plus central disease: PE ± IORT or RH or BT (latter two “in carefully selected patients with <2 cm lesions”).	RH or PE.	-	RH or PE +/− IORT; LEER.	PE; RH in <2 cm central lesions: in lateral R, PE if sciatic nerve not involved.	-	Palliative CHT for symptom control; PE or RH if in vaginal stump or uterine cervix.
Oligometastatic recurrences	EBRT +/− CHT; nodal resection/debulking + RT; TA; BT or S-RT.	Surgery +/− EBRT; TA or RA +/− EBRT; or EBRT +/− CT.	-	-	-	-	CRT or RT (EBRT or S-RT); local resection, RA, S-RT.	-	-