J Gynecol Oncol.  2016 Mar;27(2):e16. 10.3802/jgo.2016.27.e16.

Details of recurrence sites after definitive radiation therapy for cervical cancer

• Kobayashi
• Yamashita
• Okuma K
• Ohtomo K
• Nakagawa K

• KMID: 2360246
• DOI: http://doi.org/10.3802/jgo.2016.27.e16

Abstract

OBJECTIVE
This is a retrospective study aimed at clarifying the details of recurrence patterns and sites in patients with cervical cancer treated with definitive radiation therapy (RT).
METHODS
Data were analyzed from consecutive patients, admitted to the University of Tokyo Hospital (Tokyo, Japan) between 2001 and 2013, who had received definitive RT, with or without chemotherapy, for International Federation of Gynecology and Obstetrics stages IB-IVA cervical cancer.
RESULTS
One hundred and thirty-seven patients formed the patient cohort. The median follow-up period for surviving patients was 57.0 months. A complete response was achieved in 121 patients (88%). Of these, 36 (30%) developed a cancer recurrence during follow-up. The first sites of recurrence were located in intra-RT fields in nine, outside RT fields in 20, and both in seven patients. In the intra-RT field group, all patients showed a local recurrence, while no one experienced an isolated pelvic lymph node (PLN) recurrence. In the outside RT field group, the most frequent site of recurrence was lung (60%), and three-quarters of patients were free from intra-RT field recurrence until the last follow-up. Of the entire cohort, including 48 PLN-positive patients, only seven patients (5.1%) developed PLN persistence or recurrence, all in the common iliac, internal iliac, and/or obturator nodes, and all with another synchronous relapse.
CONCLUSION
Local disease was a major type of intra-RT field recurrence, while PLN control was favorable even in initially PLN-positive patients. The predominance of outside RT field recurrence alone highlights issues concerning distant control, including the intensity enhancement of systematic therapy.

Keyword

Radiation Therapy; Recurrence; Uterine Cervical Neoplasms

MeSH Terms

Adenocarcinoma/drug therapy/*radiotherapy/secondary
Adult
Aged
Aged, 80 and over
Antineoplastic Agents/therapeutic use
Brachytherapy
Carcinoma, Squamous Cell/drug therapy/*radiotherapy/secondary
Chemoradiotherapy
Disease-Free Survival
Dose Fractionation
Female
Follow-Up Studies
Humans
Lung Neoplasms/*secondary
Lymphatic Metastasis
Middle Aged
Neoplasm Recurrence, Local/*diagnosis
Pelvis
Retrospective Studies
Survival Rate
Uterine Cervical Neoplasms/drug therapy/pathology/*radiotherapy
Antineoplastic Agents