Background:Laterally extended pelvic exenteration with or without brachytherapy of the tumor bed is a novel therapeutic option from which selected patients with pelvic recurrences of cervical cancer can benefit.Methods:Patients with pelvic recurrences of cervical cancer entered into a prospective study that investigated relapse patterns, prognostic factors, and the role of extended radical treatment. Management was based on the diagnostic findings and the patients' option for therapy. From 1990‐1997, 138 patients with recurrent cervical cancer in the pelvis participated in the study.Results:Recurrent tumor size, recurrence‐free interval, and extended radical treatment with potential local control were the strongest independent prognostic factors in the multivariate regression analysis. Tumor location was not a prognostic factor. The survival rate for patients with central disease treated with exenteration alone did not differ from patients with side wall disease who underwent laterally extended pelvic exenteration with or without brachytherapy of the tumor bed.Conclusions:Patients who experienced pelvic recurrences of cervical cancer with tumors ≤ 5 cm in diameter and detected > 5 months after primary therapy benefited from extended radical treatment with potential local control, irrespective of tumor location. Because the overall prognosis for patients with pelvic tumor recurrences remains poor, means of prevention should be given a high priority.