The prognosis for recurrent cervical carcinoma following initial surgery is dismal even when aggressive radiotherapy or salvage surgery is used. We retrospectively reviewed hospital records to evaluate the efficacy and feasibility of concurrent chemoradiotherapy as a salvage treatment.
Methods
From 1999 to 2007, 47 patients received salvage chemoradiotherapy. Involved-field irradiation was delivered at a median dose of 64.8 Gy (range, 36–100.2), including brachytherapy boost in 10 patients. Pelvic re-irradiation was performed in 4 of the 12 women who had a previous history of pelvic radiotherapy. All but one patient received cisplatin-based concomitant chemotherapy during radiotherapy.
Results
The median overall follow-up period was 27 months and for surviving patients was 57 months. The interval between initial surgery and recurrence was 22 months (range, 4–203), and the median recurrent mass size was 4 cm (range, 0.5–11). In 34 patients, recurrent tumors were confined to the pelvis (21 central and 13 peripheral). Grade 3–4 acute hematologic toxicity was the most frequent toxicity and was observed in 29 (62%) women. Five-year actuarial cumulative incidence of severe gastrointestinal and genitourinary toxicity was 13% and 7%, respectively. Thirty-three patients (70%) showed a complete response and 9 (19%) a partial response following salvage chemoradiation. Five-year overall and disease-free survival rates were 44% and 41%, respectively.
Conclusions
Salvage chemoradiotherapy appears to be a feasible treatment option for women with recurrent cervical carcinoma following surgery. The treatment had a high salvage rate and acceptable late complication rate, despite being associated with substantial acute toxicity.
ParkinD.M., BrayF., FerlayJ., PisaniP.: Global cancer statistics, 2002. CA Cancer J Clin, 55: 74–108, 2005.
2.
KimY.T.: Current status of cervical cancer and HPV infection in Korea. J Gynecol Oncol, 20: 1–7, 2009.
3.
BurghardtE., BaltzerJ., TulusanA.H., HaasJ.: Results of surgical treatment of 1028 cervical cancers studied with volumetry. Cancer, 70: 648–655, 1992.
4.
DelgadoG., BundyB., ZainoR., SevinB.U., CreasmanW.T., MajorF.: Prospective surgical-pathological study of disease-free interval in patients with stage IB squamous cell carcinoma of the cervix: a Gynecologic Oncology Group study. Gynecol Oncol, 38: 352–357, 1990.
5.
FioricaJ., HollowayR., NdubisiB., OrrJ., GrendysE., BoothbyR., DeCesareS., LaPollaJ., HoffmanM., PatelJ.: Phase II trial of topotecan and cisplatin in persistent or recurrent squamous and nonsquamous carcinomas of the cervix. Gynecol Oncol, 85: 89–94, 2002.
6.
LongH.J.3rd, BundyB.N., GrendysE.C.Jr., BendaJ.A., McMeekinD.S., SoroskyJ., MillerD.S., EatonL.A., FioricaJ.V.: Randomized phase III trial of cisplatin with or without topotecan in carcinoma of the uterine cervix: a Gynecologic Oncology Group Study. J Clin Oncol, 23: 4626–4633, 2005.
7.
MooreD.H., BlessingJ.A., McQuellonR.P., ThalerH.T., CellaD., BendaJ., MillerD.S., OltG., KingS., BoggessJ.F., RoceretoT.F.: Phase III study of cisplatin with or without paclitaxel in stage IVB, recurrent, or persistent squamous cell carcinoma of the cervix: a gynecologic oncology group study. J Clin Oncol, 22: 3113–3119, 2004.
8.
NguyenH.N., NordqvistS.R.: Chemotherapy of advanced and recurrent cervical carcinoma. Semin Surg Oncol, 16: 247–250, 1999.
HaasbeekC.J., UitterhoeveA.L., van der VeldenJ., GonzalezD.G., StalpersL.J.: Long-term results of salvage radiotherapy for the treatment of recurrent cervical carcinoma after prior surgery. Radiother Oncol, 89: 197–204, 2008.
11.
IjazT., EifelP.J., BurkeT., OswaldM.J.: Radiation therapy of pelvic recurrence after radical hysterectomy for cervical carcinoma. Gynecol Oncol, 70: 241–246, 1998.
12.
ItoH., ShigematsuN., KawadaT., KuboA., IsobeK., HaraR., YasudaS., ArugaT., OgataH.: Radiotherapy for centrally recurrent cervical cancer of the vaginal stump following hysterectomy. Gynecol Oncol, 67: 154–161, 1997.
13.
JobsenJ.J., LeerJ.W., CletonF.J., HermansJ.: Treatment of locoregional recurrence of carcinoma of the cervix by radiotherapy after primary surgery. Gynecol Oncol, 33: 368–371, 1989.
KeysH.M., BundyB.N., StehmanF.B., MuderspachL.I., ChafeW.E., SuggsC.L.3rd, WalkerJ.L., GersellD.: Cisplatin, radiation, and adjuvant hysterectomy compared with radiation and adjuvant hysterectomy for bulky stage IB cervical carcinoma. N Engl J Med, 340: 1154–1161, 1999.
16.
MorrisM., EifelP.J., LuJ., GrigsbyP.W., LevenbackC., StevensR.E., RotmanM., GershensonD.M., MutchD.G.: Pelvic radiation with concurrent chemotherapy compared with pelvic and paraaortic radiation for high-risk cervical cancer. N Engl J Med, 340: 1137–1143, 1999.
17.
PetersW.A.3rd, LiuP.Y., BarrettR.J.2nd, StockR.J., MonkB.J., BerekJ.S., SouhamiL., GrigsbyP., GordonW.Jr., AlbertsD.S.: Concurrent chemotherapy and pelvic radiation therapy compared with pelvic radiation therapy alone as adjuvant therapy after radical surgery in high-risk early-stage cancer of the cervix. J Clin Oncol, 18: 1606–1613, 2000.
18.
RoseP.G., BundyB.N., WatkinsE.B., ThigpenJ.T., DeppeG., MaimanM.A., Clarke-PearsonD.L., InsalacoS.: Concurrent cisplatin-based radiotherapy and chemotherapy for locally advanced cervical cancer. N Engl J Med, 340: 1144–1153, 1999.
19.
WhitneyC.W., SauseW., BundyB.N., MalfetanoJ.H., HanniganE.V., FowlerW.C.Jr., Clarke-PearsonD.L., LiaoS.Y.: Randomized comparison of fluorouracil plus cisplatin versus hydroxyurea as an adjunct to radiation therapy in stage IIB-IVA carcinoma of the cervix with negative para-aortic lymph nodes: a Gynecologic Oncology Group and Southwest Oncology Group study. J Clin Oncol, 17: 1339–1348, 1999.
StehmanF.B., BundyB.N., DiSaiaP.J., KeysH.M., LarsonJ.E., FowlerW.C.: Carcinoma of the cervix treated with radiation therapy. I. A multi-variate analysis of prognostic variables in the Gynecologic Oncology Group. Cancer, 67: 2776–2785, 1991.
22.
ZainoR.J., WardS., DelgadoG., BundyB., GoreH., FetterG., GanjeiP., FrauenhofferE.: Histopathologic predictors of the behavior of surgically treated stage IB squamous cell carcinoma of the cervix. A Gynecologic Oncology Group study. Cancer, 69: 1750–1758, 1992.
23.
JainP., HunterR.D., LivseyJ.E., CoyleC., SwindellR., DavidsonS.E.: Salvaging locoregional recurrence with radiotherapy after surgery in early cervical cancer. Clin Oncol (R Coll Radiol), 19: 763–768, 2007.
WebbM.J., SymmondsR.E.: Site of recurrence of cervical cancer after radical hysterectomy. Am J Obstet Gynecol, 138: 813–817, 1980.
26.
CerrottaA., GardanG., CavinaR., RaspagliesiF., StefanonB., GarassinoI., MusumeciR., TanaS., De PaloG.: Concurrent radiotherapy and weekly paclitaxel for locally advanced or recurrent squamous cell carcinoma of the uterine cervix. A pilot study with intensification of dose. Eur J Gynaecol Oncol, 23: 115–119, 2002.
27.
ManeoA., LandoniF., CormioG., ColomboA., PlacaF., PellegrinoA., MangioniC.: Concurrent carboplatin/5-fluorouracil and radiotherapy for recurrent cervical carcinoma. Ann Oncol, 10: 803–807, 1999.
28.
MigliettaL., FranzoneP., CenturioniM.G., BoniL., TacchiniL., CossoM., BoccardoF., FerrariniM., BruzzoneM.: A phase II trial with cisplatin-paclitaxel cytotoxic treatment and concurrent external and endocavitary radiation therapy in locally advanced or recurrent cervical cancer. Oncology, 70: 19–24, 2006.
29.
SmaniottoD., D'AgostinoG., LuziS., ValentiniV., MacchiaG., MantiniG., MargaritiP.A., FerrandinaG., ScambiaG.: Concurrent 5-fluorouracil, mitomycin C and radiation with or without brachytherapy in recurrent cervical cancer: a scoring system to predict clinical response and outcome. Tumori, 91: 295–301, 2005.
30.
ThomasG.M., DemboA.J., MyhrT., BlackB., PringleJ.F., RawlingsG.: Long-term results of concurrent radiation and chemotherapy for carcinoma of the cervix recurrent after surgery. Int J Gynecol Cancer, 3: 193–198, 1993.
31.
WindschallA., OttO.J., SauerR., StrnadV.: Radiation therapy and simultaneous chemotherapy for recurrent cervical carcinoma. Strahlenther Onkol, 181: 545–550, 2005.
32.
MohiuddinM., MarksG., MarksJ.: Long-term results of reirradiation for patients with recurrent rectal carcinoma. Cancer, 95: 1144–1150, 2002.
33.
DoganN., KingS., EmamiB., MohideenN., MirkovicN., LeybovichL.B., SethiA.: Assessment of different IMRT boost delivery methods on target coverage and normal-tissue sparing. Int J Radiat Oncol Biol Phys, 57: 1480–1491, 2003.
34.
D'SouzaW.D., AhamadA.A., IyerR.B., SalehpourM.R., JhingranA., EifelP.J.: Feasibility of dose escalation using intensity-modulated radiotherapy in posthysterectomy cervical carcinoma. Int J Radiat Oncol Biol Phys, 61: 1062–1070, 2005.
35.
GuerreroM., LiX.A., MaL., LinderJ., DeyoungC., EricksonB.: Simultaneous integrated intensity-modulated radiotherapy boost for locally advanced gynecological cancer: radio-biological and dosimetric considerations. Int J Radiat Oncol Biol Phys, 62: 933–939, 2005.
36.
KimY.S., ShinS.S., NamJ.H., KimY.T., KimY.M., KimJ.H., ChoiE.K.: Prospective randomized comparison of monthly fluorouracil and cisplatin versus weekly cisplatin concurrent with pelvic radiotherapy and high-dose rate brachytherapy for locally advanced cervical cancer. Gynecol Oncol, 108: 195–200, 2008.
37.
LeeM.Y., WuH.G., KimK., HaS.W., KimJ.S., KimI.A., LeeH.P.: Concurrent radiotherapy with paclitaxel/carboplatin chemotherapy as a definite treatment for squamous cell carcinoma of the uterine cervix. Gynecol Oncol, 104: 95–99, 2007.
