Reirradiation in Rcurrent Cervical Cancer Following Definite Radiation Therapy

Kim, Jin Hee; Choi, Tae Jin; Kim, Ok Bae

Abstract

PURPOSE: To evaluate treatment results in terms of local control, complications and survival after reirraidiation in recurrent cervical cancer following definite radiation therapy. MATERIAL AND METHODS: From November 1987 through March 1998, eighteen patients with recurrent cervical cancer following definite radiation therapy were subsequently treated with reirradiation at Keimyung University Dongsan Medical Center. In regard to the initial FIGO stage, one patient was stage Ia, five were stage IIa, three were IIb, two were IIb and two were IVa. The age range was 37 to 79 years old with median age of 57. The time interval from initial definite radiation therapy to recurrence ranged from 6 to 122 months with a median of 58 months. The recurrent sites were the uterine cervix in seven patients, vagina in ten and pelvic lymph node in one. Reirradiation was performed with external radiation and intracavitary radiation in twelve patients, external radiation and implantation in four and external radiation alone in two. The range of external radiation dose was 2,100~5,400 cGy and the range of the total radiation dose was 3,780~8,550 cGy. The follow-up periods ranged from 8 to 20 months with median of 25 following reirradiation.
RESULTS
Fourteen of eighteen patients (78%) had local control just after reirradiation. The two year disease free survival (2YDFS) rate was 53.6%. There were statistically significant differences in the 2YDFS according to both recurrent site (2YDFS 28.5% in uterine cervix, 71.4% in vagina, ( p=0.03)) and the total dose (2YDFS 71.8% in >6,000 cGy , 25% in < OR = 6,000 cGy, p=0.007). Seven of ten patients who were followed for more than 20 months remain alive and disease free (7/18, 39%). Patients treated with external radiation and intracavitary radiation had a higher rate of 2YDFS. Seven patients including 4 patients with no local control experienced local failure in the uterus or vagina and two patients died with distant metastasis. Complications included rectal bleeding in 3 patients, bowel obstruction treated with surgery in two, hematuria in one, radiation cystitis in two, soft tissue swelling in two and vaginal necrosis spontaneously healed in one. There was no statistical difference in complications according to the total dose or the time to recurrence from initial radiation.
CONCLUSION
In patients with recurrence following definite radiation therapy in the uterine cervical cancer, reirradiation may be effective but requires an effort to reduce radiation induced severe complications.