Efficacy and prognosis of radiotherapy for patients with postoperative pelvic recurrence in uterine cervical cancer

Abstract

Objective To analyze the result and adverse reactions of radiation therapy in patients with pelvic recurrence following cervical cancer postoperative. Methods A retrospective analysis of 147 patients with pelvic recurrence after surgical treatment of cervical cancer in the Fourth Hospital of Hebei Medical University from August 2004 to December 2016 was performed. All patients received radiotherapy with or without chemotherapy. According to different clinical factors and pathological factors, Logistic regression analysis was used to analyze the factors influencing radiotherapy outcomes in patients with pelvic recurrence after cervical cancer surgery. The Kaplan-Meier method was used to analyze the survival rate, and the corresponding survival curve was drawn. The survival rate and prognosis related factors were compared by using the log-rank test. The COX proportional hazards regression model was used for multivariate analysis of statistically relevant factors in univariate analysis. After treatment, toxicities were analyzed using chi-square test. Results The median follow-up time was 33.2 months. 95% of the patients completed radiation therapy with a dose of ≥67 Gy (median radiotherapy dose), and 91 patients (61.9%) had complete remission (CR). The 5-year local control (LC), progression-free survival (PFS), distant metastasis-free survival (DMFS), and overall survival (OS) were 63.6%, 56.0%, 73.9%, and 55.0%, respectively. Univariate logistic regression analysis showed that FIGO staging (stage 0-ⅠB and ⅡA-ⅡB), pelvic sidewall involvement, and recurrent tumor volume were associated with complete remission (P<0.05). Multivariate statistical analysis found that FIGO staging and pelvic sidewall invasion were independent factors influencing the efficacy and survival of patients with pelvic recurrence after cervical cancer surgery (P<0.05). Patients with pelvic wall invasion after cervical cancer surgery had a higher incidence of ≥grade 2 proctitis than those without pelvic walls involved, which were 26.9% and 16.7%, respectively. Conclusions This study shows that after the surgical treatment of cervical cancer patients with pelvic recurrence can be tolerated by toxicities after radiation therapy. In addition, the incidence of toxicities in patients with pelvic wall invasion was significantly higher than those without pelvic wall invasion. Preoperative staging and the pelvic wall involvement are independent influencing factors influencing the effect of radiotherapy and long-term prognosis in patients with pelvic recurrence after cervical cancer surgery. Key words: Postoperative cervical cancer; Pelvic recurrence; Radiotherapy; Toxicities; Survival rate