After definitive radiation therapy (RT) for locally advanced uterine cervical cancer, local residual tumor has been subsequently found in approximately 5–10% of patients. Although adjuvant salvage hysterectomy is often attempted for those patients, radiation induced fibrosis and regrowth of the tumor after long elapsed time from RT can lead to high-risk surgery or inoperable cases. The aim of the current study was to clarify the significance of early evaluation for residual cervical cancer after RT to identify patients who may benefit from adjuvant salvage hysterectomy. We performed a retrospective cohort study between February 2012 and July 2016 of 179 patients with FIGO stage IB1–IVA cervical cancer treated with RT. For all patients, we have been conducting early evaluations for residual tumor 4 weeks after RT. In our institution, the decision to perform adjuvant salvage hysterectomy is based on at least 2 of these following 4 criteria: tumor-like cervical mass in magnetic resonance imaging (MRI) findings, abnormal fluorodeoxyglucose uptake in positron emission tomography-computed tomography (PET-CT) images, suspicious cytology or histology, and elevated tumor marker values (SCC, CA19-9, CA125, or CEA). Patients who were strongly suspected to have residual tumor underwent adjuvant salvage hysterectomy. Statistical analyses were conducted with Fisher’s exact test and Mann-Whitney’s U test. Among 179 patients, 11 patients (6%) underwent adjuvant salvage hysterectomy. The histology was squamous cell carcinoma (SqCC) in 6 patients and adenocarcinoma in 5 patients (4 of mucinous adenocarcinoma and 1 of endometrioid adenocarcinoma). The median tumor size prior to RT was 57mm (range: 45-77mm) in patients with SqCC and 42mm (range: 35-67mm) in those with adenocarcinoma (P = 0.12). In all patients, tumor was detected on MRI images after 4 weeks from RT. The median tumor-size of after RT was 22mm (range: 10-30mm) in patients with SqCC, and 30mm (range: 18-55mm) in those with adenocarcinoma, respectively (P = 0.17). No significant difference was observed in the SUV-max values on PET-CT images after RT between patients with SqCC (median: 3.9, range: 1.8-4.1) and those with adenocarcinoma (median: 3.9, range: 3.1-27.8, P = 1.0), and the ratio of the elevated tumor marker values (SCC: 17% vs. CA19-9: 20%, P = 1.0). Pathological examination after adjuvant salvage hysterectomy showed that viable tumor was observed in 1 of 6 patients with SqCC (17%) and all 5 patients with adenocarcinoma (100%): the difference was statistically significant (P < 0.05). After adjuvant salvage hysterectomy, local control was 100% in all 11 patients, and distant metastasis was shown in 1 patient with SqCC and 1 patient with adenocarcinoma. Patients with suspicious residual uterine cervical tumor of adenocarcinoma 4 weeks after RT have a higher incidence of viable tumor compared to those with SqCC, and might benefit from adjuvant salvage hysterectomy for local control.