POSTSURGICAL RECURRENT CARCINOMA OF THE CERVIX - REASSESSMENT AND RESULTS OF RADIATION-THERAPY OPTIONS

PURPOSE: To evaluate outcome and reassess the radiation therapy option s in pelvic recurrences of cervical cancer treated initially with surg ery. MATERIALS AND METHODS: In 30 patients, the prognostic factors ana lyzed for local control included site of recurrence (central, pelvic w all), tumor size, modality of radiation therapy, and radiation dose. M ean follow-up in survivors was 111.5 months. RESULTS: Local control wa s attained in (a) nine of 20 patients with central recurrence and in t wo of 10 with pelvic wall recurrence (P = .25); (b) none of four who r eceived less than 50 Gy, five of nine who received 50 - 60 Gy, and six of 17 who received greater than 60 Gy (P = .27); and (c) five of 11 w ith tumor smaller than 3 cm, five of nine with tumor size 3 - 6 cm, an d one of 10 with tumor larger than 6 cm. Multivariate analysis reveale d a significant benefit of local control on survival (P = .05). Median survival for patients with central recurrence was 14.5 months compare d with 9 months for those with pelvic wall recurrence. CONCLUSION: Loc al pelvic control depends on site and size of recurrence and radiation therapy modality and dose. Appropriate choice of brachytherapy modali ty is important. To improve local control and survival, more aggressiv e treatment is indicated, but attendant higher complications may be ex pected.