RADIATION-THERAPY OF PELVIC RECURRENCE AFTER RADICAL HYSTERECTOMY FORCERVICAL-CARCINOMA

Objectives. To evaluate the efficacy of radiation therapy and potentia l prognostic factors in patients treated for pelvic recurrence of cerv ical carcinoma after radical hysterectomy. Materials. The records of 5 0 patients treated between 1964 and 1994 for an isolated pelvic recurr ence of cervical carcinoma a median of 10.5 months after initial radic al hysterectomy were retrospectively reviewed. Patients were categoriz ed according to the extent of disease on clinical examination as group 1, mucosal involvement only (5); group 2, paravaginal extension (11); group 3, central recurrence with pelvic wall extension (13); and grou p 4, recurrences limited to the pelvic sidewall(21). Seven patients wi th group 3 or 4 disease who had a poor performance status were treated with palliative intent using hypofractionated radiotherapy. The remai ning 43 patients were treated with curative intent, 33 with radiothera py only and 10 with a combination of cisplatin-based chemotherapy and radiotherapy, Survival rates were calculated from the date of initial recurrence. Median follow-up of surviving patients was 109 months. Res ults. The overall 5-year survival rate was 33% for all 50 patients (me dian survival, 18 months), 39% for the 43 patients treated with curati ve intent, and 25% for patients with isolated sidewall recurrences tre ated with curative intent. The survival rate was 69% for patients with group 1 and 2 disease and 18% for those treated with curative intent for group 3 disease (P = 0.07), The survival rate was better for patie nts with recurrent squamous carcinomas (51%) than for those with adeno carcinomas (14%) (P = 0.05). Three group 4 patients who survived more than 5 years were treated with external-beam radiation alone, Eight-on e percent of patients who had a second recurrence had evidence of dise ase progression, Three patients experienced late treatment complicatio ns. Conclusions. Patients who experience an isolated recurrence of cer vical cancer after initial radical hysterectomy have an excellent prog nosis if disease does not involve the pelvic wall. Occasional long-ter m survivors of recurrent disease involving the pelvic wall justify an aggressive treatment approach. (C) 1998 Academic Press.