Radical hysterectomy for recurrent or persistent cervical cancer followingradiation therapy

The objective of this paper was to determine the role of radical hysterecto my in persistent or recurrent cervical cancer after primary radiation thera py. Between 1982 and 1995, 34 patients underwent radical hysterectomy for persi stent (n = 15) or recurrent (n = 19) cervical cancer after primary radiothe rapy. Univariate analysis using log-rank comparison of survival curves was conducted to identify clinical and pathologic factors predictive of surviva l. The median tumor size at the time of recurrence or persistence was 3.2 c m (range 1-6 cm). 24 patients (70%) had recurrence limited to the uterine c ervix; four (12%) had vaginal involvement and six (18%) had early parametri al involvement. No treatment-related deaths were observed. Eighteen major c omplications (grade III-IV) occurred in 15 cases (44%); 5 patients experien ced a fistula. Mean follow-up time was 81 months (range 33-192 months). Rec urrent disease was documented in 20 patients (59%), and median time to recu rrence was 37 months (range 4-56 months). Fifteen patients (44%) are alive without evidence of disease at a median survival of 81 months (range 33-192 ), and 18 patients (53%) died of disease with a median survival of 22 month s (range 7-106). One patient died of intercurrent disease. Actuarial 5-year survival rate for the whole group is 49%. Patients with FIGO stage IB-IIA at primary diagnosis, no clinical parametrial involvement, and small (less than or equal to 4 cm) tumor diameter at the time of recurrence show a good prognosis (11/17 alive NED) compared to patients who do not fit the above mentioned criteria (4/17 NED, P 0.01). We conclude that radical hysterectom y can be offered as an alternative procedure to exenteration only in highly selected patients.