Details of recurrence sites after definitive radiation therapy for cervical cancer

Abstract

ObjectiveThis is a retrospective study aimed at clarifying the details of recurrence patterns and sites in patients with cervical cancer treated with definitive radiation therapy (RT).MethodsData were analyzed from consecutive patients, admitted to the University of Tokyo Hospital (Tokyo, Japan) between 2001 and 2013, who had received definitive RT, with or without chemotherapy, for International Federation of Gynecology and Obstetrics stages IB–IVA cervical cancer.ResultsOne hundred and thirty-seven patients formed the patient cohort. The median follow-up period for surviving patients was 57.0 months. A complete response was achieved in 121 patients (88%). Of these, 36 (30%) developed a cancer recurrence during follow-up. The first sites of recurrence were located in intra-RT fields in nine, outside RT fields in 20, and both in seven patients. In the intra-RT field group, all patients showed a local recurrence, while no one experienced an isolated pelvic lymph node (PLN) recurrence. In the outside RT field group, the most frequent site of recurrence was lung (60%), and three-quarters of patients were free from intra-RT field recurrence until the last follow-up. Of the entire cohort, including 48 PLN-positive patients, only seven patients (5.1%) developed PLN persistence or recurrence, all in the common iliac, internal iliac, and/or obturator nodes, and all with another synchronous relapse.ConclusionLocal disease was a major type of intra-RT field recurrence, while PLN control was favorable even in initially PLN-positive patients. The predominance of outside RT field recurrence alone highlights issues concerning distant control, including the intensity enhancement of systematic therapy.

Clinical impact of boost irradiation to pelvic lymph node in uterine cervical cancer treated with definitive chemoradiotherapy

“…Multivariate analysis revealed that pelvic LN involvement and primary mass response after radiotherapy were significant factors affecting OS and PFS. In a recent study, Kobayashi et al [ 24 ] have analyzed the details of recurrences after definitive radiation without boost irradiation. They found that half of non-CR patients (8 of 16 patients) showed local persistence and recurrence.…”

Gynecologic cancer surveillance in the era of SARS-CoV-2 (COVID-19)

“…These patients are usually symptomatic and have extrapelvic sites involved Review in up to 75% of cases. 38 Nevertheless, selected patients with small central pelvic tumors will be considered potentially curable. 31 33 38 Recommendations ► Follow-up in cases of high-risk cervical cancer may be performed through face-to-face visits with physical examination and clinical assessment by gynecologic oncologists together or through telemedicine with one of the oncologists from the multidisciplinary team every 3 months during the first 2 years (figure 2).…”

Concurrent Chemoradiation for Mediastinal Oligometastases From Cervical Cancer: A Potentially Curative Treatment

“…In the series by Kobayashi et al, among 137 patients, one had mediastinal oligorecurrence treated with concurrent chemoradiation. However, the outcome of this individual patient was not specified [ 16 ]. In 2013, Kesarwani reported the case of one patient with unresectable mediastinal oligometastases treated with 50.4-Gy radiation therapy concurrent with weekly cisplatin, with a complete response at 16 months of follow-up [ 17 ].…”