Conversion-oriented multimodal therapy enabling definitive surgery in a patient with FIGO stage IVA cervical cancer at high risk of fistula formation: a case report.

Background: FIGO stage IVA cervical cancer is frequently associated with extensive pelvic organ invasion and high treatment complexity. In selected patients with severe hemorrhage, renal dysfunction, or poor baseline condition, delivery of standard therapy may be clinically challenging. Case Presentation: We report a patient with FIGO stage IVA cervical squamous cell carcinoma presenting with massive vaginal bleeding, severe anemia, and renal dysfunction caused by extensive invasion of the rectum, bladder, distal ureter, and lower vagina. Emergent hemostatic radiotherapy achieved rapid bleeding control and clinical stabilization. Subsequently, an individualized conversion-oriented multimodal strategy integrating radiotherapy, targeted therapy, immunotherapy, and later consolidation chemotherapy was adopted with surgery as the intended endpoint. During treatment, serial image-guided radiotherapy (IGRT) monitoring prompted repeat CT simulation, target volume recontouring, and adaptive replanning according to tumor regression, enabling progressive reduction of irradiated target volumes while limiting unnecessary radiation exposure to adjacent pelvic organs. Marked tumor regression was achieved, followed by definitive radical surgery and pathologic complete response without recurrence during follow-up. Conclusion: This case suggests that, in highly selected patients with FIGO stage IVA cervical cancer, an individualized conversion-oriented multidisciplinary strategy incorporating IGRT-based monitoring and adaptive replanning may facilitate subsequent radical surgery and durable disease control. However, further clinical validation is required.