Long-term results of salvage radiotherapy for the treatment of recurrent cervical carcinoma after prior surgery.
ABSTRACT Tumor recurrence after surgery for cervical carcinoma is associated with high fatality and morbidity, forming a major therapeutic challenge. This paper presents our experience with treatment of this patient group by salvage radiotherapy with curative intent.
Thirty-five patients with a pelvic recurrence after hysterectomy received high-dose radiotherapy. A retrospective analysis of long-term outcome and prognostic factors was performed.
After a median follow-up period of 12.1 years, actuarial 2-,5- and 10-year overall survival rates were 66%, 43% and 33%; disease-free survival rates were 62%, 45% and 41%, respectively. Pelvic control rates at 2-,5- and 10-years were 77%, 69% and 62%. Unfavorable prognostic factors on univariate analysis for survival were: recurrence extending to the pelvic wall versus central recurrence, early recurrence after surgery, external boost versus brachytherapy boost, low total dose and high age. Only a brachytherapy boost and a long interval between surgery and recurrence were significant on multivariate analysis. Severe complications (> or = grade 3) were seen in 6 patients (17%; actuarial after 5 years, 21%).
Salvage radiotherapy for recurrent cervical carcinoma following surgery may result in 40-50% long-term disease-free survival and an acceptable risk of severe treatment complications, even in patient with recurrences extending to the pelvic wall.
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- "If the published data are all in accordance to recommend increasing the dose to pelvic nodes by using the results of PET–CT, further studies are necessary to better define the total dose to the para-aortic nodes as they might not be necessary if the main carcinological events are distant metastases. Recurrent cervical carcinoma can also be salvaged with radiotherapy and PET–CT helps in limiting the irradiated volumes, specially to decrease the risk of complications after surgery . "
ABSTRACT: PET-CT plays an increasing role in the diagnosis and treatment of gynaecological cancers. In cervix cancer, whilst MRI remains the best imaging technique for initial primary tumor staging, PET-CT has been showed to be a highly sensitive method to determine lymph node status, except in patients with early-stage cervical cancer where PET-CT cannot replace surgical exploration of pelvic lymph nodes. In patients with advanced cervical cancer, PET-CT has the potential of showing lymph node metastasis not only within the pelvis, but also outside the pelvis, more particularly in the para-aortic area. PET-CT has also been described as a useful tool in 3-D-based adaptative brachytherapy. In endometrial cancer, the issues are different, as the recent decade has seen a therapeutic decrease in early-stage disease, especially in postoperative radiation therapy, whilst more advanced disease have been approached with more aggressive treatments, integrating chemotherapy and external beam radiotherapy. Lymph node status is also an important issue and PET-Scan may replace lymph node surgical procedure particularly in obese patients.Radiotherapy and Oncology 09/2010; 96(3):351-5. DOI:10.1016/j.radonc.2010.07.010 · 4.86 Impact Factor
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ABSTRACT: The prognosis for recurrent cervical carcinoma following initial surgery is dismal even when aggressive radiotherapy or salvage surgery is used. We retrospectively reviewed hospital records to evaluate the efficacy and feasibility of concurrent chemoradiotherapy as a salvage treatment. From 1999 to 2007, 47 patients received salvage chemoradiotherapy. Involved-field irradiation was delivered at a median dose of 64.8 Gy (range, 36-100.2), including brachytherapy boost in 10 patients. Pelvic re-irradiation was performed in 4 of the 12 women who had a previous history of pelvic radiotherapy. All but one patient received cisplatin-based concomitant chemotherapy during radiotherapy. The median overall follow-up period was 27 months and for surviving patients was 57 months. The interval between initial surgery and recurrence was 22 months (range, 4-203), and the median recurrent mass size was 4 cm (range, 0.5-11). In 34 patients, recurrent tumors were confined to the pelvis (21 central and 13 peripheral). Grade 3-4 acute hematologic toxicity was the most frequent toxicity and was observed in 29 (62%) women. Five-year actuarial cumulative incidence of severe gastrointestinal and genitourinary toxicity was 13% and 7%, respectively. Thirty-three patients (70%) showed a complete response and 9 (19%) a partial response following salvage chemoradiation. Five-year overall and disease-free survival rates were 44% and 41%, respectively. Salvage chemoradiotherapy appears to be a feasible treatment option for women with recurrent cervical carcinoma following surgery. The treatment had a high salvage rate and acceptable late complication rate, despite being associated with substantial acute toxicity.Tumori 96(4):553-9. · 1.09 Impact Factor
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ABSTRACT: While the incidence of cervical cancer has declined significantly in the USA, ethnic disparities remain in terms of increased mortality and morbidity. Furthermore, this disease continues to be a significant burden on developing countries, with cervical cancer currently ranked as the second most common cause of cancer-related morbidity and the third most common cause of mortality worldwide. Treatment of cervical cancer has typically been viewed as surgical with possible adjuvant therapy versus initial radiotherapy and platinum-based chemotherapy. Prognosis and therapy for patients with recurrent disease is dependent upon the site of recurrence and ability to pursue curative therapy. This article will review the management of cervical cancer, including studies that have evaluated the treatment of distant metastasis or recurrent disease, as well as discussing the importance of angiogenesis and the use of therapies targeted against this phenomenon.Expert Review of Anti-infective Therapy 08/2009; 9(7):895-903. DOI:10.1586/era.09.58 · 2.28 Impact Factor