Radiotherapy for Postoperative Recurrent Uterine Cervical Carcinoma

Abstract

From January 1980 to December 1985, a total of 110 patients with postoperative recurrent uterine cervical carcinoma were treated with radiotherapy. The mean age was 53 years. Ten patients were excluded due to incomplete treatment. The population was grouped according to the classification by Ciatto et al. into patients with central recurrence (n = 48), with peripheral limited recurrence (n = 43), and with peripheral massive recurrence (n = 9). The midpelvic dose given to patients with central recurrence was 40 to 45 Gy, followed by a boost given either by perineal teletherapy with 30 Gy or brachytherapy with 30 Gy at 0.5 cm. beneath the vaginal mucosa. For the peripheral group, the midpelvic dose was 50 Gy followed by a boost of 10 Gy through reduced portals. Further boost to the vaginal mucosa was given by either of the two methods mentioned above. The overall 5-year survival rate was 28%. In the group with central recurrence, it was 42% and in the group with peripheral recurrence 15%. Sixteen patients had persistent local tumor and 15 patients developed distant metastasis. Complications noted were proctitis (5%), cystitis (2%), vesicovaginal fistula (2%) and rectovaginal fistula (2%). Our data clearly indicate that radiotherapy was effective in controlling central recurrence, but for peripheral recurrence, control rate and prognosis were less favorable.

Positron emission tomography/computerised tomography imaging in detecting and managing recurrent cervical cancer: systematic review of evidence, elicitation of subjective probabilities and economic modelling

“…[86][87][88]90,92 In Hille et al, 86 grade 3 late toxicity was observed in 8% of patients, including intestinal bleeding after 7 months and fistulae between the rectosigmoid colon and the vagina, removed subsequently by surgery. In Ito et al, 87 late complications of radiotherapy, including intestinal and urinary complications of grade 2 and grade 3, occurred in 32% of patients.…”

“…In Jain et al, 88 one patient suffered from morbidity in the sigmoid colon requiring surgical resection and in Lucraft 90 seven cases of complications were observed, including transient proctitis, intermittent haematuria and severe acute bowel reactions. In Tan et al, 92 major complications included fistulae, proctitis and cystitis (see Table 44). …”

“…The interventions are radiotherapy or radiotherapy with chemotherapy (chemoradiotherapy). The search for relevant studies did not identify any RCTs but 16 case series met the inclusion criteria: nine evaluated radiotherapy [84][85][86][87][88][89][90][91][92] and seven evaluated chemoradiotherapy. [93][94][95][96][97][98][99] The results of the quality assessment for the radiotherapy and chemoradiotherapy studies are presented in Appendix 15.…”

“…The best-quality RCT found compared cisplatin with no cisplatin with both groups receiving radiotherapy, 127 which gave an overall 5-year survival with cisplatin of 63% and without cisplatin of 59%. Only case series were found on radiotherapy (nine studies [84][85][86][87][88][89][90][91][92] ), chemoradiotherapy (seven studies [93][94][95][96][97][98][99] ), radical hysterectomy (seven studies [100][101][102][103][104][105][106] ) and pelvic exenteration (20 studies [107][108][109][110][111][112][113][114][115][116][117][118][119][120][121][122][123][124][125][126] ). The survival rates varied considerably, depending on the date of publication, characteristics of patients and type of treatment given.…”

“…Most of the nine case series [84][85][86][87][88][89][90][91][92] included a small number of patients (median 82 cases, range 18-130 cases). Study locations included the UK, the USA, Japan, the Netherlands and Germany.…”