Salvage Radiotherapy Strategy and Its Prognostic Significance for Patients With Locally Recurrent Cervical Cancer After Radical Resection: a Retrospective 10-year Analysis

Abstract Background: Salvage radiotherapy modes for treating patients with local cervical cancer recurrence after radical surgery are controversial. Therefore, we aimed to evaluate the clinical efficacy and prognostic significance of two radiotherapy modes—involved-field radiotherapy combined with regional lymph nodes (regional radiotherapy) and involved-field radiotherapy alone (local radiotherapy)—in these patients.Methods: We retrospectively enrolled patients with local recurrence who underwent radical surgery without radiotherapy for early-stage cervical cancer from January 2010 to January 2020. Clinical outcomes were analyzed using the Kaplan–Meier method and a Cox proportional hazards model.Results: Forty-four patients underwent intensity-modulated radiotherapy (IMRT)-based salvage treatment. The 5-year overall survival and progression-free survival rates were 64% and 60.2%, respectively. Sixteen of 18 patients with stump recurrence and 15 of 26 patients with pelvic and abdominal cavity recurrence received regional radiotherapy, while others received local radiotherapy. Univariate analysis showed that patients with stump recurrence, who underwent regional radiotherapy, and with a lower systemic inflammation response index (SIRI) had better prognosis than their counterparts. Patients aged < 51 years, with stump recurrence, recurrence time ≤ 24 months, recurrence site=1, and a lower SIRI who received regional radiotherapy had a better prognosis than patients who received local radiotherapy. SIRI correlated with the recurrence site and radiotherapy mode.Conclusion: Locally recurrent cervical cancer treated with IMRT-based salvage therapy has a good prognosis. Recurrence site, SIRI, and the radiotherapy mode significantly influenced prognosis. Regional radiotherapy may be suitable for patients with stump recurrence, recurrence time ≤ 24 months, and one recurrence site.

Download Full-text

Is salvage radiotherapy optimal to patients with occult cervical cancer undergoing inadvertent simple hysterectomy? A propensity score-matched analysis of a nationwide clinical oncology database

Japanese Journal of Clinical Oncology ◽

10.1093/jjco/hyaa251 ◽

2021 ◽

Author(s):

Yanhong Wang ◽

Yi Ouyang ◽

Jingjing Su ◽

Lihua Xiao ◽

Zhigang Bai ◽

...

Keyword(s):

Cervical Cancer ◽

Overall Survival ◽

Propensity Score ◽

Radical Surgery ◽

Figo Stage ◽

Salvage Radiotherapy ◽

Radiotherapy Group ◽

Surgery Group ◽

Group Matching

Abstract Objective We used National Cancer Institute’s Surveillance, Epidemiology and End Result database to assess the role of salvage radiotherapy for women with unanticipated cervical cancer after simple hysterectomy. Methods Patients with non-metastatic cervical cancer and meeting inclusion criteria were divided into three groups based on treatment strategy: simple hysterectomy, salvage radiotherapy after hysterectomy and radical surgery. Parallel propensity score-matched datasets were established for salvage radiotherapy group vs. simple hysterectomy group (matching ratio 1: 1), and salvage radiotherapy group vs. radical surgery group (matching ratio 1:2). The primary endpoint was the overall survival advantage of salvage radiotherapy over simple hysterectomy or radical surgery within the propensity score-matched datasets. Results In total, 2682 patients were recruited: 647 in the simple hysterectomy group, 564 in the salvage radiotherapy group and 1471 in the radical surgery group. Age, race, histology, grade, FIGO stage, insured and marital status and chemotherapy were comprised in propensity score-matched. Matching resulted in two comparison groups with neglectable differences in most variables, except for black race, FIGO stage III and chemotherapy in first matching. In the matched analysis for salvage radiotherapy vs. simple hysterectomy, the median follow-up time was 39 versus 32 months. In the matched analysis for salvage radiotherapy vs. radical surgery, the median follow-up time was 39 and 41 months, respectively. Salvage radiotherapy (HR 0.53, P = 0.046) significantly improved overall survival compared with simple hysterectomy, while salvage radiotherapy cannot achieve similar overall survival to radical surgery (HR 1.317, P = 0.045). Conclusions This is the largest study of the effect of salvage radiotherapy on overall survival in patients with unanticipated cervical cancer. Salvage radiotherapy can improve overall survival compared with hysterectomy alone, while cannot achieve comparable survival to radical surgery.

Download Full-text

Salvage Radiotherapy for Lymph Node Recurrence after Radical Surgery in Cervical Cancer

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/j.ijrobp.2010.07.980 ◽

2010 ◽

Vol 78 (3) ◽

pp. S416-S417

Author(s):

W. Jeon ◽

H. Kim ◽

S. Ha ◽

H. Wu ◽

S. Kim

Keyword(s):

Cervical Cancer ◽

Lymph Node ◽

Radical Surgery ◽

Salvage Radiotherapy ◽

Lymph Node Recurrence

Download Full-text

Intraoperative Electron Beam Radiotherapy during Radical Surgery for Locally Advanced and Recurrent Cervical Cancer

Gynecologic Oncology ◽

10.1006/gyno.2001.6329 ◽

2001 ◽

Vol 82 (3) ◽

pp. 538-543 ◽

Cited By ~ 44

Author(s):

R. Martı´nez-Monge ◽

M. Jurado ◽

J.J. Aristu ◽

M. Moreno ◽

M. Cambeiro ◽

...

Keyword(s):

Cervical Cancer ◽

Electron Beam ◽

Radical Surgery ◽

Locally Advanced ◽

Recurrent Cervical Cancer ◽

Electron Beam Radiotherapy

Download Full-text

Prognostic significance of the bcl-2 apoptotic family of proteins in primary and recurrent cervical cancer

British Journal of Cancer ◽

10.1038/bjc.1998.466 ◽

1998 ◽

Vol 78 (2) ◽

pp. 210-214 ◽

Cited By ~ 45

Author(s):

RA Crawford ◽

C Caldwell ◽

RK Iles ◽

D Lowe ◽

JH Shepherd ◽

...

Keyword(s):

Cervical Cancer ◽

Prognostic Significance ◽

Recurrent Cervical Cancer

Download Full-text

One hundred autotransplants for relapsed or refractory Hodgkin's disease and lymphoma: value of pretransplant disease status for predicting outcome.

Journal of Clinical Oncology ◽

10.1200/jco.1993.11.12.2351 ◽

1993 ◽

Vol 11 (12) ◽

pp. 2351-2361 ◽

Cited By ~ 114

Author(s):

A P Rapoport ◽

J M Rowe ◽

P A Kouides ◽

R A Duerst ◽

C N Abboud ◽

...

Keyword(s):

Mortality Rate ◽

Hodgkin's Disease ◽

Hodgkin’S Disease ◽

Prognostic Significance ◽

High Dose ◽

Bulky Disease ◽

Disease Mortality ◽

Minimal Disease ◽

Involved Field ◽

Involved Field Radiotherapy

PURPOSE One hundred autotransplants for Hodgkin's disease (HD) or non-Hodgkin's lymphoma (NHL) were examined prospectively to identify variables with prognostic significance. PATIENTS AND METHODS Ninety-six patients with relapsed or refractory HD or NHL underwent 100 autotransplants. Patients received high-dose carmustine (BCNU), etoposide, cytarabine, and cyclophosphamide (BEAC) followed by unpurged autologous stem-cell rescue. RESULTS The 3-year actuarial event-free survival (EFS) rate for the 47 HD patients is 49%, with a median followup duration of 2 years. For the 53 NHL patients, the 3-year actuarial EFS rate is 40%, with a median follow-up duration of 19 months. By multivariate analysis, minimal disease on admission (all areas < or = 2 cm) is associated with improved EFS (HD, P = .003, NHL, P = .03). The projected EFS rate for HD patients entering with minimal disease is 70% versus 15% for patients with bulky disease (P = .0001). The projected EFS rate for NHL patients with minimal disease is 48% versus 25% for patients with bulky disease (P = .04). Posttransplant involved-field radiotherapy, administered to 26 of the last 61 patients, was associated with an improved EFS rate for NHL patients (P = .015). The BEAC regimen was well tolerated by patients who entered the study with minimal disease (mortality rate, < 5%), but caused significant toxicity in patients with bulky disease (mortality rate, 25%). CONCLUSION Disease burden before autotransplantation is an important predictor of regimen-related toxicity and EFS. Posttransplant involved-field radiotherapy may improve outcomes in select patients with NHL. The BEAC regimen is safe and effective, particularly for patients with minimal disease.

Download Full-text