RADIOTHERAPY FOR CENTRALLY RECURRENT CERVICAL-CANCER OF THE VAGINAL STUMP FOLLOWING HYSTERECTOMY

Purpose: This study was performed to establish the classification and the treatment modality for recurrent cervical cancer of the vaginal st ump after hysterectomy. Patients and methods: Ninety patients with cen trally recurrent cervical cancer of the vaginal stump following hyster ectomy were treated with high-dose-rate intracavitary brachytherapy wi th or without external irradiation. The intervals between primary surg ery and vaginal recurrences varied from 3 months to 36 years, Tumor si ze of the vaginal stump was determined by bimanual rectovaginal examin ation at the time of recurrence and was classified into three groups, i.e., small (no palpable tumor), medium (less than 3 cm), and large (3 cm or more). Results: The 10-year survival rates for all patients wer e 52%, Survival was greatly influenced by the tumor sizes of the vagin al stump. The 10-year survival rates of patients with small, medium, a nd large size tumors were 72, 45, and 0%, respectively, All patients w ith large size turners died within 5 years. Of 90 patients, 75 (83%) w ere determined by physical examination to be free of tumor on at least one visit within 2 months of the completion of treatment (CR). The re maining 15 patients (17%) had physical findings suggestive of residual tumor (Residual). The overall 10-year survival rate for all patients with CR was 63%, compared with 10% for the patients with Residual (P < 0.0001), The incidences of distant metastases of the patients with or without local failure were 55 and 13%, respectively (P < 0.0001). The patients with local failure had significantly higher incidence of met astases. Most patients with small size tumor were treated with brachyt herapy alone, and the survival rates of these patients were not improv ed by combination with external irradiation. Conclusion: These results suggest that tumor size was a significant prognostic factor for recur rent cervical cancer of the vaginal stump. Patients with small size tu mors were recommended to be treated with brachytherapy alone. (C) 1997 Academic Press.