Therapeutic outcome and prognostic factors in the radiotherapy of recurrences of cervical carcinoma following surgery.
Hille A, Weiss E, Hess CF.
Department of Radiotherapy, University of Gottingen, Germany. firstname.lastname@example.org
PURPOSE: To evaluate the efficacy of radiotherapy in patients with recurrences of cervical carcinoma.
PATIENTS AND METHODS: 26 patients who underwent radiation therapy for recurrences of cervical carcinoma following surgery between 1989 and 1999 were retrospectively analyzed. 17 patients had inoperable or macroscopic residual tumor.
Nine patients had a complete/microscopically incomplete tumor resection. Depending on tumor burden and location of the recurrence, external beam radiotherapy or a combination with brachytherapy was delivered to a total dose of 50-65 Gy.
RESULTS: The 5-year overall survival was 28%, relapse-free survival 24%, pelvic control 48%. Therapeutic outcome was related to the margins of resection, location of recurrence and technique of radiotherapy.
In case of surgery without residual or microscopic tumor, the 5-year survival rate was 67%, with macroscopic tumor no patient was alive after 37 months (p = 0.05). 5-year overall survival was 42% for central recurrences, 10% for recurrences with pelvic wall infiltration.
Recurrences confined to the vagina or paravaginal tissue had a higher 5-year overall probability as compared to all other patients (57% vs. 14%).
All patients treated with combined radiotherapy were alive, whereas all patients treated only with external radiotherapy were dead after 32 months (p = 0.01).
CONCLUSION: 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.
Strahlenther Onkol. 2003 Nov;179(11):742-7.
Int J Rad Onc, Bio, Phys, 11/07
BMJ, October 2007
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