Long-term results of salvage radiotherapy for the treatment of recurrent cervical carcinoma after prior surgery.

Department of Radiotherapy, Academic Medical Center, Amsterdam, The Netherlands.
Radiotherapy and Oncology (Impact Factor: 4.86). 02/2008; 89(2):197-204. DOI: 10.1016/j.radonc.2008.01.004
Source: PubMed

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 [27]. "
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