Therapeutic Outcome and Prognostic Factors in the Radiotherapy of Recurrences of Cervical Carcinoma Following Surgery

Abstract

The probability of controlling recurrence mostly depends on a small tumor burden with the possibility of brachytherapy and/or complete surgery. Aggressive treatment modalities like radiochemotherapy and/or higher radiation doses are needed, especially for recurrences with infiltration of the pelvic wall and/or with macroscopic tumor.

Positron emission tomography/computerised tomography imaging in detecting and managing recurrent cervical cancer: systematic review of evidence, elicitation of subjective probabilities and economic modelling

“…[86][87][88]90,92 In Hille et al, 86 grade 3 late toxicity was observed in 8% of patients, including intestinal bleeding after 7 months and fistulae between the rectosigmoid colon and the vagina, removed subsequently by surgery. In Ito et al, 87 late complications of radiotherapy, including intestinal and urinary complications of grade 2 and grade 3, occurred in 32% of patients.…”

“…The interventions are radiotherapy or radiotherapy with chemotherapy (chemoradiotherapy). The search for relevant studies did not identify any RCTs but 16 case series met the inclusion criteria: nine evaluated radiotherapy [84][85][86][87][88][89][90][91][92] and seven evaluated chemoradiotherapy. [93][94][95][96][97][98][99] The results of the quality assessment for the radiotherapy and chemoradiotherapy studies are presented in Appendix 15.…”

“…Most of the nine case series [84][85][86][87][88][89][90][91][92] included a small number of patients (median 82 cases, range 18-130 cases). Study locations included the UK, the USA, Japan, the Netherlands and Germany.…”

“…Study locations included the UK, the USA, Japan, the Netherlands and Germany. The majority of women presented with early-stage cervical cancer, but in three studies 86,87,91 there was no information about FIGO stage. The proportion of patients with recurrent or persistent disease in the pelvis as the only site of cancer (central recurrence) was lower than the proportion developing distant metastases.…”

“…The best-quality RCT found compared cisplatin with no cisplatin with both groups receiving radiotherapy, 127 which gave an overall 5-year survival with cisplatin of 63% and without cisplatin of 59%. Only case series were found on radiotherapy (nine studies [84][85][86][87][88][89][90][91][92] ), chemoradiotherapy (seven studies [93][94][95][96][97][98][99] ), radical hysterectomy (seven studies [100][101][102][103][104][105][106] ) and pelvic exenteration (20 studies [107][108][109][110][111][112][113][114][115][116][117][118][119][120][121][122][123][124][125][126] ). The survival rates varied considerably, depending on the date of publication, characteristics of patients and type of treatment given.…”