Primary Treatment Of Cervical Cancer Research Articles

Trends of minimally invasive surgery in the primary treatment of cervical cancer.

Minimally invasive surgery (MIS), including laparoscopic and robot-assisted procedures, has rapidly advanced in the treatment of gynecologic malignancies worldwide. However, its adoption and insurance coverage in AOFOG countries remain limited, particularly for advanced uterine and ovarian cancers. This limitation poses a challenge to the widespread use of MIS, highlighting the need for a more comprehensive evaluation of its role and the skills required by gynecologic oncologists to ensure safe and effective treatment. Furthermore, the Laparoscopic Approach to Cervical Cancer trial significantly impacted perceptions of MIS, revealing higher recurrence rates and inferior overall survival for minimally invasive radical hysterectomy (MIS-RH) compared to abdominal radical hysterectomy. Subsequent studies confirmed these findings, raising questions about the suitability of MIS-RH, particularly in centers with limited experience. Key issues affecting MIS outcomes include surgical expertise and tumor spillage prevention. As the landscape of cervical cancer treatment evolves, the integration of radiotherapy, chemotherapy, and immune therapies has challenged the traditional reliance on surgical monotherapy. There also exists ongoing debate over the optimal use of MIS in primary treatment and salvage surgery for cervical cancer to refine MIS techniques and explore their role in preserving fertility and managing residual disease post-chemoradiotherapy. For ensuring MIS as a viable treatment option, it is continuously necessary accumulating real-world data and reassessing surgical strategies to balance efficacy, safety, and patient preferences.

103: The Impact of IMRT on Outcomes in the Primary Treatment of Cervical Cancer: A Single Institution Experience

103: The Impact of IMRT on Outcomes in the Primary Treatment of Cervical Cancer: A Single Institution Experience

ACCEPTANCE: protocol for a feasibility study of a multicomponent physical activity intervention following treatment for cervical cancer

IntroductionCervical cancer treatment can have life changing sequelae and be associated with poor short-term and long-term quality of life. Physical activity (PA; that is, bodily movement) is known to improve...

The Impact of High-Dose-Rate Brachytherapy: Measuring Clinical Outcomes in the Primary Treatment of Cervical Cancer

PurposeRadical concurrent chemoradiotherapy with combined external beam radiotherapy (EBRT) and brachytherapy is used to treat locally advanced cervical cancer. Our institution has transitioned to high-dose-rate (HDR) intracavitary brachytherapy (ICBT) from low-dose-rate (LDR) brachytherapy in 2008, and a review was conducted on the effect of this change on patient outcomes. Methods and MaterialsA single-arm retrospective chart review was performed on locally advanced (Fédération Internationale de Gynécologie et d’Obstétrique stage IB-IVA) patients with cervical cancer treated with combined external beam radiation therapy and HDR-ICBT with curative intent between 2008 and 2014. Clinical outcomes were evaluated, and multivariate analysis was performed to identify prognostic factors. ResultsOf the 76 patients selected, median age was 47.9 years and median follow-up was 5.2 years. Thirteen patients (17.1%) developed locoregional recurrence and 23 patients (30.3%) patients developed distant recurrence. Five-year progression-free survival and overall survival were 63.7% and 69.3%, respectively. A significant survival difference was found between stages (P < .001). Multivariate analysis found nodal involvement was strongly associated with poorer survival (P = .007). ConclusionsOur experience with the transition to HDR-ICBT as part of concurrent chemoradiotherapy in treatment of locally advanced cervical cancer resulted in acceptable long-term outcomes and toxicity to that of LDR brachytherapy. Potential further improvement of treatment outcomes for patients may be possible with image guided brachytherapy and the addition of effective systemic therapy.

Radical Hysterectomy: Efficacy and Safety in the Dawn of Minimally Invasive Techniques

To analyze the effect that the introduction of minimally invasive procedures has had on surgical and oncologic outcomes when compared with conventional open radical hysterectomy (ORH) in a national reference cancer after 17 years of experience in radical hysterectomy. A prospective controlled study (Canadian Task Force classification II-2). A university teaching hospital. All patients who underwent radical hysterectomy as primary treatment for cervical cancer in our institution between May 1999 and June 2016, with a total of 188 patients. Patients underwent ORH or minimally invasive surgery (MIS) (i.e., laparoscopic or robotically assisted radical hysterectomy). Seventy-six patients underwent ORH, 90 laparoscopic radical hysterectomy, and 22 robotically assisted radical hysterectomy. Blood loss and hospital stay were inferior in the MIS group (p <.0001). The laparotomic group presented shorter operation times (p = .0001). With a median follow-up of 112.4 months, a total of 156 patients (83%) were alive and free of disease at the time of the data analysis. Overall survival was higher in the MIS group when compared with the ORH group (91 vs 78.9, p = .026). There were no differences regarding recurrence rates between the surgical approaches. With 1 of the largest follow-up periods in the literature, this study provides added evidence that MIS could become the preferable surgical approach for early-stage cervical cancer since it appears to reduce morbidity without affecting oncologic results.

Intensity-modulated radiotherapy combined with iodine-125 seed implantation in non-central recurrence of cervical cancer: A case report and literature review.

Recurrent cervical cancer is a clinically complex disease that is difficult to treat. There are numerous treatment options, but the results achieved by each are poor. External-beam radiation therapy of the pelvic lymph drainage area, in combination with intracavitary afterloading or the interstitial implantation of a radiation source (i.e., brachytherapy), are the current standard radiotherapy regimens used in high-risk clinical targets. However, there are few reports concerning the use of iodine-125 (125I) seed implantation brachytherapy in recurrent cervical cancer, and the effects of treatment and adverse reactions have not yet been systematically evaluated. In the present study one such case is reported, in which the patient was successfully treated with intensity-modulated radiotherapy (IMRT) in combination with 125I seed implantation. The patient, a 47-year-old woman, was initially diagnosed with International Federation of Gynecology and Obstetrics stage IB1 cervical cancer, and received a radical hysterectomy, left lateral adnexectomy and pelvic lymph node dissection. A follow-up examination 23 months later revealed vaginal invasion and a solitary lump in the cervical stump with a maximum diameter of 38 mm. The patient was subsequently diagnosed with recurrent cervical cancer and was treated with six cycles of docetaxel and nedaplatin chemotherapy, alongside IMRT and interstitial 125I seed implantation. At the point of manuscript submission, the patient's progression-free survival time was 33 months and long-term adverse reactions were acceptable. The response of this patient indicates that 125I seed implantation could be used as a complementary treatment for recurrent cervical cancer and may also prove to be a reliable means for the comprehensive treatment of primary cervical cancer, as the patient had characteristics similar to primary cervical cancer, although this hypothesis could not be confirmed in the present study.

The Incident of Diarrhea among Cervical Cancer Patients Post Chemoterapy Treatment

Backgrounds : Cervical cancer is second most diseases suffered by women. Chemotherapy is primary treatment for cervical cancer. Chemotherpy has some side effect, and one of them is diarrhea. Diarrhea make cervical cancer suffered more. The purpose of this research was to analyze the correlation of factor’s that cause diarrhea on cervical cancer.Methods : This research uses descriptive analitic method with retrospective design. The population in this research is all patients who had post first chemotherapy. Sample in this study were 21 respondents, with purposive sampling. Variable independent were type of chemotherapy drugs, character of chemotheraphy, staging, stress and dietary. Variable dependent was diarrhea. Data collected using quesionare. Data were analyzed using chi square test with level of significant α≤0,05.Results : The result of the study reveals that type of the chemotherapy drug p:0,598, character of chemotheraphy p:0,336,. Staging has correlation with diarrhea significant of p:0,022. Stress and dietary analysisis presented p:0,00. It means that there was significant correlation with diarrhea.Conclusion : It can be concluded that diarrhea incident related to staging, stress and dietarry. There‘s no correlation between type of chemotherapy drug, character of chemotheraphy with diarrhea Further studies should give health education about dietary causing diarrhea, chemotherapy procedural and sides effect’s, increase supports for patient with cervical cancer.

DIARRHEA INCIDENT IN CERVICAL CANCER PATIENTS POST CHEMOTHERAPY TREATMENT

Backgrounds : Cervical cancer is second most diseases suffered by women. Chemotherapy is primary treatment for cervical cancer. Chemotherpy has some side effect, and one of them is diarrhea. Diarrhea make cervical cancer suffered more. The purpose of this research was to analyze the correlation of factor’s that cause diarrhea on cervical cancer.Methods : This research uses descriptive analitic method with retrospective design. The population in this research is all patients who had post first chemotherapy. Sample in this study were 21 respondents, with purposive sampling. Variable independent were type of chemotherapy drugs, character of chemotheraphy, staging, stress and dietary. Variable dependent was diarrhea. Data collected using quesionare. Data were analyzed using chi square test with level of significant α≤0,05.Results : The result of the study reveals that type of the chemotherapy drug p:0,598, character of chemotheraphy p:0,336,. Staging has correlation with diarrhea significant of p:0,022. Stress and dietary analysisis presented p:0,00. It means that there was significant correlation with diarrhea.Conclusion : It can be concluded that diarrhea incident related to staging, stress and dietarry. There‘s no correlation between type of chemotherapy drug, character of chemotheraphy with diarrhea Further studies should give health education about dietary causing diarrhea, chemotherapy procedural and sides effect’s, increase supports for patient with cervical cancer. Keyword: Cervical Cancer, Chemotherapy, Diarrhea.

Prognostic implication of human papillomavirus types and species in cervical cancer patients undergoing primary treatment.

High-risk human papillomavirus (HPV) types are associated with cervical cancer. It is well established that individual HPV types vary in oncogenicity, but current data on their prognostic implication remain controversial. We examined the association between HPV types/species and the survival of 236 Chinese women aged 26–87 (mean 54.4) years after receiving primary treatment for cervical cancer. Overall, 45.8% were of FIGO stage I, 41.9% stage II, and 12.3% stage III. The four most prevalent types found were HPV-16 (60.2%), HPV-18 (21.6%), HPV-52 (11.9%), and HPV-58 (9.3%). Overall, 19.5% of patients had multiple-type infections, 78.4% harboured one or more alpha-9 species, and 28.8% harboured one or more alpha-7 species. After a median follow-up of 8.0 years, 156 (66.1%) patients survived. The 3-year overall survival rate was 75.5%. Factors independently associated with a poorer 3-year overall survival were age >60 years, tumour size >4 cm, lymph node involvement and treatment with radiotherapy+/-chemotherapy. Univariate analysis showed HPV-16 single-type infection was associated with a marginally poorer disease-specific survival (71.6% vs. 87.0%, HR: 1.71, 95% CI = 1.01–2.90), whereas non-HPV-16 alpha-9 species was associated with a better disease-specific survival (90.0% vs. 76.2%, HR: 0.36, 95% CI = 0.16–0.79). However, on multivariate analysis, HPV infection status irrespective of different grouping methods, including individual types, species, single-type or co-infection, did not carry any significant prognostic significance. In conclusion, we did not observe any association between infection with a particular HPV type/species and survival. An HPV type-based stratification in treatment and follow-up plan could not be recommended.

Correlation between Expression of MVP, Index of p53 and AgNOR Value with Chemoradiotherapy Clinical Response of Cervical Cancer

Cervical cancer is the most frequent cancer found in Indonesia. The primary treatment of cervical cancer at the locally advanced stage is usually performed by using radiotherapy and chemotherapy. The combination of the two techniques is often called chemoradioherapy. The response to chemoradiotherapy is influenced by biological and physical factors. Major vault protein (MVP) is a ribonucleoprotein which contributes to drug resistance in some cancers. The purposes of this research were: (1) to determine the correlation between the expression of MVP and the index of p53, including AgNOR values and index of MIB-1; and (2) between MVP and chemoradiotherapy clinical response of cervical cancer. Twenty-one microscopic slides taken from biopsy tissues of cervical cancer patients before undergoing treatment were stained to identify MVP, p53, and MIB-1 by means of immunohistochemistry techniques and AgNORs staining. After undergoing chemoradiotherapy treatment, the patients’ clinical responses were observed by pelvic control method. Experimental results showed that there was a correlation between MVP and AgNOR value (P=0.05), but no correlation between MVP and index of p53 (P=0.729), including MIB-1 LI (P=0.63), in untreated cervical cancer. In addition, there was no association between MVP and chemoradioterapy response. In conclusion, MVP expression correlates with the process of cell proliferation before the G2 phase of cell cycle in untreated cancer cells. Those have no association with clinical responses after the completion of treatment. Received: 20 November 2013; Revised: 18 July 2014; Accepted: 28 September 2014

Patient preferences for side effects associated with cervical cancer treatment.

The aim of this study was to assess patient preferences regarding side effects associated with cervical cancer treatment. The visual analog scale (VAS) and modified standard gamble (SG) were used to elicit preferences of women with no evidence of disease after primary treatment of cervical cancer. Higher scores on VAS and SG indicated more favorable ratings for a given health state. Health states (HS) included vaginal shortening, diarrhea, dietary changes, menopause, moderate nausea/vomiting, rectal bleeding, sexual dysfunction, and urinary self-catheterization. Descriptive statistics, Kruskal-Wallis, Mann-Whitney U, and Wilcoxon signed-ranks tests and correlation coefficients were used for statistical analysis. Seventy-eight patients participated in the study. Median age was 44.1 years (range, 24.9-67.8 years). Median time since treatment completion was 31.2 months (range, 1.0-113.3 months). The HSs rated as most favorable by VAS were also rated as most favorable by SG. Increasing age was associated with higher VAS scores for menopause and vaginal shortening (P = 0.04 and 0.036). African Americans had higher VAS scores for dietary changes (P = 0.05), sexual dysfunction (P = 0.028), and diarrhea (P = 0.05) when compared with Hispanic and non-Hispanic white patients. Women receiving radiation had more favorable VAS scores for menopause compared with women undergoing radical hysterectomy (P = 0.05). Women receiving chemotherapy rated urinary self-catheterization less favorably by VAS score compared with those not receiving chemotherapy (P = 0.045). Multiple demographic and clinical factors influence the severity of treatment-related adverse effects perceived by women surviving cervical cancer. A better understanding of factors influencing patient preferences regarding treatment side effects will allow providers to formulate care better tailored to the individual desires of each patient.

Hedgehog signalling in primary cervix xenograft (OCICx) models: A potential new therapeutic target in combination with chemoradiotherapy.

11120 Background: Overcoming treatment resistance and repopulation in patients undergoing chemo-radiotherapy for primary treatment of cervical cancer is critical in order to improve long-term survival. Upregulation of Hh gene expression in women with cervical cancer prior to chemoradiotherapy is associated with a worse outcome. Aim: to investigate inhibition of the Hh pathway in combination with chemoradiotherapy in orthotopic primary cervical cancer xenograft models (OCICX). Methods: mRNA expression levels of Hh pathway members were characterized using qRT-PCR analysis in OCICx models. To simulate clinical treatment 5E1 (antibody blocking SHH and IHH ligand interaction with PTCH1) was administered to mice bearing cervix xenografts (20 mg/kg/weekly) with localized fractionated irradiation (15 x 2Gy fractions given 5 days/wk over 3 wks). Tumor growth delay, lymph node metastases, survival and toxicity were assessed. Results: The OCICX models exhibited matched levels of Hh gene expression compared to the pa...

Follow-up protocols for women with cervical cancer after primary treatment

Cervical cancer is the second most common cancer among women up to 65 years of age and is the most frequent cause of death from gynaecological cancers worldwide. Although surveillance of women after completion of primary treatment for cervical cancer is purported to have an impact on their overall survival (OS), no strictly defined follow-up protocols are available for these women. Wide diversity in management has been noted in the follow-up of women who have completed primary treatment for cervical cancer. Traditionally, women treated for cervical cancer undergo routine long-term, even life-long, follow-up. The primary objective of this practice has been to detect and treat recurrence early. This review sets out to systematically evaluate available evidence for the role of different models of follow-up after cervical cancer and the optimal use of investigations. To evaluate the benefits, harms and costs of different follow-up protocols for women who have completed primary treatment for cervical cancer. We searched CENTRAL (The Cochrane Library 2013, Issue 1), the Cochrane Gynaecological Cancer Group (CGCG) Trials Register, MEDLINE and EMBASE up to January 2013. We also searched registers of clinical trials, abstracts of scientific meetings and reference lists of clinical guidelines and review articles and contacted experts in the field. We searched for randomised controlled trials (RCTs) that compared different follow-up protocols after primary treatment in women with cervical cancer. Two review authors independently assessed whether potentially relevant studies met the inclusion criteria. No trials were found, and therefore no data were analysed. The search strategy identified 1,377 unique references, of which all were excluded on the basis of title and abstract. We found no evidence to inform decisions about different follow-up protocols after primary treatment for women with cervical cancer. Ideally, a large RCT or, at the very least, well-designed non-randomised studies (NRSs) that use multi-variate analysis to adjust for baseline imbalances are needed to compare these follow-up protocols. Such studies could include prospective trials conducted to determine the benefits and harms of different follow-up protocols upon completion of primary treatment for cervical cancer, along with an RCT undertaken to compare predefined follow-up protocols versus participant-initiated follow-up versus no follow-up until a participant is referred to a gynaecological oncology service after signs or symptoms of recurrence have been identified in the primary care or community setting.

Role of F-18 fluorodeoxyglucose positron emission tomography/computed tomography in the detection of recurrence in patients with cervical cancer

Introduction:Treatment of cervical cancer is usually surgery in the early stages and radiotherapy or chemoradiotherapy in more advanced stages of the disease. Recurrence may occur in multiple sites following primary treatment. Although recurrent metastatic disease is not curable, surgical treatment may be of great help if locoregional recurrence is detected early. Fluorine-18 Fluorodeoxyglucose positron emission tomography - computed tomography (F-18 FDG PET/CT) forms an important part of investigations in the diagnosis of clinically suspicious recurrent cervical cancer.Objective:To assess the role of F-18 FDG PET/CT in diagnosing recurrence in patients with clinical suspicion of recurrent cervical cancer.Materials and Methods:We retrospectively evaluated 53 histopathologically proved patients of cervical cancer. All the patients had been treated with either surgery/radiation therapy with or without chemotherapy. The standard PET/CT acquisition protocol, with delayed post void static pelvic images, wherever required, was followed in all patients. Significant uptake of FDG in the lymph nodes was considered to be a recurrence suggestive of metastasis. Para-aortic lymph nodal involvement was considered to be distant metastasis. Any significant uptake in the lung nodule on FDG PET was evaluated either by histological confirmation, by taking fine needle aspiration cytology (FNAC), or by a follow-up chest CT done after three months.Results:Of the 53 patients with clinically equivocal recurrence, FDG PET/CT suggested recurrence in 41 patients (local recurrence in 14 patients and distant recurrence/metastasis with or without local recurrence in 27 patients). It had a sensitivity of 97.5%, a specificity of 63.6%, positive predictive value of 90.9%, and negative predictive value of 87.5%.Conclusion:PET/CT appears to have an important role in detecting recurrence following primary treatment of cervical cancer. The high positive and negative predictive values of PET/CT may be helpful in planning management of recurrent cervical cancer.

Review of radiotherapy and hyperthermia in primary cervical cancer

This review focuses on combined radiotherapy and hyperthermia for the primary treatment of cervical cancer compared to the current international standard of chemoradiation. Practical considerations, biological effects and clinical results are discussed.

Evaluating Contemporary Radiotherapy Approaches in the Primary Treatment of Cervical Cancer

Radiotherapy with concurrent cisplatinum-based chemotherapy became a standard recommendation for the management of advanced cervical cancer in 1999. We reviewed our experience with this approach to determine the impact on patient outcomes. A retrospective review of all cervical cancer patients treated with curative intent using radical radiotherapy +/- chemotherapy from 1992 to 2005 was performed. Survival and relapse rates were analyzed using the Kaplan-Meier method and were compared using the log-rank test. During this period, 224 treated patients were identified: 153 (68%) were treated between 1992 and 1999 (group 1) and 71 (32%) were treated after 1999 (group 2). The median age was 53 and 55 years with a median follow-up of 49 and 34 months for groups 1 and 2, respectively. Stage classification and histological diagnosis were similar for both groups. Treatment usually consisted of external beam pelvic radiotherapy (40-45 Gy in 20-25 fractions) followed by low-dose rate brachytherapy (35-40 Gy to point A). Chemotherapy consisted of weekly intravenous cisplatinum (40 mg/m2) given concurrently with pelvic radiation. The proportion of patients receiving chemotherapy increased significantly after 1999, 12% in group 1 compared with 79% in group 2 (P < 0.01). The 5-year overall survival (OS) and progression-free survival (PFS) rates were 53% and 54% for group 1 and 64% and 67% for group 2. The improvement in PFS for group 2 approached statistical significance (P = 0.06), but the difference in OS did not. There has been a significant increase in the use of concurrent chemoradiation for cervical cancer treatment after 1999, and this seems to have led to higher rates of PFS and OS, although these have yet to achieve statistical significance.

Concurrent carboplatin and paclitaxel with pelvic radiation therapy in the primary treatment of cervical cancer

The objective of the study was to determine the feasibility of weekly carboplatin/paclitaxel with radiation therapy (RT) in the primary treatment of cervical cancer. Women diagnosed with stage IB-1 to stage IVA untreated primary cervical cancer were eligible. Carboplatin (area under the curve = 2.0) and paclitaxel 40 mg/m2 were administered weekly for 6 weeks with pelvic RT. Brachytherapy was completed after pelvic RT. Acute toxicities and response to treatment were assessed. Twenty-two evaluable patients were enrolled. The median duration of follow-up was 23 months. Carboplatin (mean dose 245 mg) and paclitaxel (mean dose 70 mg) were successfully administered in 97% and 90% of planned treatments, respectively. Median time to complete external radiation therapy was 36.6 days (25-57 days). Grade 3/4 hematologic or gastrointestinal toxicity was unusual. The complete response rate 3 months after completion of therapy was 91%. The estimated 3-year progression-free survival is 70% and overall survival is 65%. Weekly carboplatin/paclitaxel and RT is a reasonable treatment regimen for cervical cancer.

Weekly gemcitabine and cisplatin in combination with pelvic radiation in the primary therapy of cervical cancer: A phase I trial of the Puget Sound Oncology Consortium

Objective. Define the maximum tolerated dose of weekly gemcitabine given concomitantly with standard weekly cisplatin and pelvic radiotherapy for primary treatment of cervical cancer. Methods. Gemcitabine at specified dose levels was given concomitantly with weekly cisplatin at 40 mg/m 2 for six cycles with concurrent radiotherapy in primary therapy of stage IB–IVA cervix cancer. Radiation consisted of 4500–5000 cGy in 25 daily fractions combined with brachytherapy to take point A to ≥8500 cGy. Results. At gemcitabine 100 mg/m 2, three of six patients demonstrated a dose limiting toxicity (DLT). At gemcitabine 50 mg/m 2, two of two had DLTs. DLTs consisted of severe fatigue, lymphopenia, diarrhea, and tinnitus. All patients had a clinical complete response; four pathologically confirmed. Two patients recurred outside the radiated field and seven are disease-free (median follow-up 30 months). Following the second DLT at gemcitabine 50 mg/m 2, the trial was stopped according to predetermined criteria. Conclusions. Adding low dose weekly gemcitabine to cisplatin and pelvic radiotherapy resulted in an excellent response but unacceptable toxicities. Addition of gemcitabine prior to weekly cisplatin with radiation for cervical cancer will likely require reduction of cisplatin doses.

Guidelines for the Treatment of Recurrent and Metastatic Cervical Cancer

Although there have been important advances in the management of women with cervical cancer, the optimal treatment for patients with locally recurrent and metastatic disease is still problematic, and there are relatively few randomized trials to guide treatment decisions. This paper reviews the approach to management of patients who relapse after primary treatment for cervical cancer. Patients who are still potentially curable with radical treatment are identified, and the various treatment strategies are discussed. However, most women are treated with palliative intent, and the literature on palliative management is reviewed together with the levels of evidence.

Recurrent cervical cancer: detection and prognosis

Background. Only a small proportion of cervical cancer recurrences is detected during routine follow‐up. We investigated which percentage of recurrences is detected during follow‐up, which diagnostic tools are helpful to detect recurrent disease and which factors are of prognostic significance once recurrent disease has been established in patients treated for cervical cancer stage IB–IVA.Methods. Characteristics of the primary tumor, characteristics of recurrent disease and follow‐up were collected retrospectively from clinical records of 277 patients who achieved a complete remission of at least 3 months after primary treatment for cervical cancer in 1992, 1993 and 1994 in three university hospitals in the Netherlands.Results. Of 277 patients, 47 (17%) developed recurrent disease; this was most often detected after self‐referral (45%), and in 32% during routine follow‐up. Survival did not differ significantly between these two groups. The presence of symptoms (87%) was the most important first abnormal test result leading to diagnosis of recurrence. In univariate analysis, disease‐free interval (DFI) and treatment modality were significant prognostic factors for crude survival of recurrence. However, treatment modality varied considerably and the subgroups were small. Therefore, multivariate analysis was not feasible and clinically valid conclusions could not be drawn.Conclusions. In only 32% of all cases, recurrence was detected during a scheduled follow‐up visit. In the majority of patients, recurrent cervical cancer was detected by symptoms (87%). In recurrent disease, DFI was a prognostic factor for survival.