LONG-TERM RESULTS OF CONCURRENT RADIATION AND CHEMOTHERAPY FOR CARCINOMA OF THE CERVIX RECURRENT AFTER SURGERY

Between 1981 and 1991, 41 patients with carcinoma of the cervix recurr ent only in the pelvis, or pelvis and para-aortic nodes after initial surgery, were treated with concurrent chemo-radiation (CT-RT). The tot al dose of radiation was tailored to the disease extent. Radiation was delivered to the pelvis and/or pelvis plus para-aortic nodes. Concurr ent infusional 5-fluorouracil 1.5 g m-2 day-1 was delivered with bid r adiation for one to three courses of 3 or 4 days. In addition, 10 pati ents received one or two courses of intravenous mitomycin C (Mit C) 6 MgM-2 . Twenty-three of 40 evaluable (58%) had a complete response to CT-RT. Five have subsequently relapsed, two in pelvis alone, one in pe lvis and distant sites and two with distant metastases only. Eighteen of 40 (45%) remain alive without disease from 3 to 113 months (median 57 months) after CT-RT. Sustained complete remissions and apparent cur e have occured even in poor pronosis patients with pelvic side wall or common iliac nodal diease and those recurrent at short intervals from surgery. Using logistic regression the following varibles were examin ed for their prognostic significance for pelvic control and survival: Mit C, extent of pelvic diseases number of course of 5-FU, nodal statu s at original surgery and radiation dose. On multivariate analysis onl y the number of courses of 5-FU used was predictive of pelvic control and survival. Concurrent 5-FU and radiation is recommended as salvage therapy for patients wth recurrent locoregional cervical cancer.