Abstract
ObjectiveThe role of salvage radiotherapy (RT) in the treatment for vaginal recurrence of cervical cancer in patients after prior surgery remains controversial. The aim of this study was to evaluate the efficacy and toxicity of salvage RT and explore prognostic factors associated with the survival after recurrence.MethodsPatients with cervical cancer, treated for vaginal recurrences at Peking Union Medical College Hospital between July 2011 and November 2019, were identified. All the patients underwent prior surgery for primary tumor and received salvage RT including external beam radiotherapy (EBRT), brachytherapy (BT), or both. The irradiation field and dose depended on the conditions of patients. Recurrence patterns were classified into four categories according to the site of recurrence. Prognostic factors on the overall survival (OS), progression-free survival (PFS), and local control (LC) were analyzed, and late toxicity was evaluated.ResultsA total of 141 patients were included in the analysis, with a median follow-up time of 40.8 months. The estimated 5-year OS, PFS, and LC rates were 81%, 75%, and 87%, respectively. In multivariate analysis, endovaginal recurrence and no irradiation history were favorable prognostic factors associated with OS (all p < 0.05), PFS (all p < 0.05), and LC (all p < 0.05). The area under the receiver operating characteristic (ROC) curve (AUC) of the recurrence pattern is larger than the stage of primary tumor (0.734 vs. 0.670).ConclusionsRT was an effective treatment with tolerable toxicity for vaginal recurrences of cervical cancer in patients with prior surgery. Recurrence pattern and irradiation history were important prognostic factors.
Highlights
Cervical cancer is the fourth most common cancer among females, which threatens the health of middle-aged and elderly women
The optimal salvage treatment regimen includes salvage radiotherapy (RT), chemotherapy, and reoperation such as pelvic exenteration depending on the primary treatment, type of recurrence, and associated comorbidities
Few studies paid attention to the effect of combined external beam radiotherapy (EBRT) and BT as salvage treatment, as well as prognostic factors associated with survival after vaginal recurrence
Summary
Cervical cancer is the fourth most common cancer among females, which threatens the health of middle-aged and elderly women. Hysterectomy is an important part of surgery for earlystage cervical cancer [1, 2]. Whether it is open surgery or minimally invasive surgery, 10%–30% cervical cancer patients experience disease relapse [3, 4]. Studies on the effect and survival of RT as a salvage treatment for recurrent cervical cancer patients with prior surgery are still limited [13, 14]. Few studies paid attention to the effect of combined external beam radiotherapy (EBRT) and BT as salvage treatment, as well as prognostic factors associated with survival after vaginal recurrence
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