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Salvage radiotherapy with or without concurrent chemotherapy for pelvic recurrence after hysterectomy alone for early-stage uterine cervical cancer

Salvage-Radiotherapie mit oder ohne gleichzeitige Chemotherapie bei Beckenrezidiv nach alleiniger Hysterektomie im frühen Stadium des Gebärmutterhalskrebses

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Abstract

Purpose

Treatment outcomes of patients with pelvic recurrence after hysterectomy alone for uterine cervical cancer who received salvage radiotherapy (RT) with or without concurrent chemotherapy were investigated.

Methods

Salvage RT for recurrent cervical cancer confined to the pelvic cavity after hysterectomy alone was received by 33 patients. The median interval between initial hysterectomy and recurrence was 26 months. Whole-pelvic irradiation was delivered to median dose of 45 Gy, followed by a boost with a median dose of 16 Gy to the gross tumor volume. Cisplatin-based concurrent chemotherapy was administered to 29 patients.

Results

The median follow-up period was 53 months for surviving patients. Most patients (97.0%) completed salvage RT of ≥45 Gy. Complete response (CR) was achieved in 23 patients (69.7%). Pelvic sidewall involvement and evaluation with positron-emission tomography-computed tomography were significantly associated with CR. The 5‑year progression-free survival (PFS), local control (LC), distant metastasis-free survival (DMFS), and overall survival (OS) rates were 62.7, 79.5, 72.5, and 60.1%, respectively. Initial International Federation of Gynecology and Obstetrics stage, pelvic sidewall involvement, and CR status were significant factors for PFS and OS rates in multivariate analysis. The incidence of severe acute and late toxicities (≥grade 3) was 12.1 and 3.0%, respectively.

Conclusion

Aggressive salvage RT with or without concurrent chemotherapy for recurrent cervical cancer confined to the pelvic cavity was feasible, with promising treatment outcomes and acceptable toxicities. However, even more intensive novel treatment strategies should be investigated for patients with unfavorable prognostic factors.

Zusammenfassung

Zielsetzung

Untersuchung der Behandlungsergebnisse von Patientinnen mit Beckenrezidiv nach alleiniger Hysterektomie bei Zervixkarzinom, die eine Salvage-Radiotherapie (RT) mit oder ohne begleitende Chemotherapie erhalten hatten.

Methoden

Insgesamt 33 Patientinnen erhielten eine Salvage-RT für ein auf die Beckenhöhle begrenztes Rezidiv des Zervixkarzinoms nach alleiniger Hysterektomie. Der mediane Zeitraum zwischen der Hysterektomie und dem Rezidiv betrug 26 Monate. Die Bestrahlung betraf das gesamte Becken mit einer medianen Dosis von 45 Gy, danach folgte eine Wiederholung mit einer medianen Dosis von 16 Gy auf die gesamte Tumormasse. Eine begleitende cisplatinbasierte Chemotherapie bekamen 29 Patientinnen.

Ergebnisse

Der mediane Nachbeobachtungszeitraum für überlebende Patientinnen betrug 53 Monate. Die meisten Patientinnen (97,0 %) schlossen die Salvage-RT mit ≥45 Gy ab. Ein vollständiges Ansprechen („complete response“, CR) erreichten 23 Patientinnen (69,7 %). Beckenwandbeteiligung und Beurteilung mittels Positronenemissionstomographie-Computertomographie standen in deutlichem Zusammenhang mit einem CR. Die Raten für progressionsfreies 5‑Jahres-Überleben (PFS), lokale Kontrolle (LC), fernmetastasenfreies Überleben (DMFS) und Gesamtüberleben (OS) lagen bei jeweils 62,7 %, 79,5 %, 72,5 % und 60,1 %. In der multivariaten Analyse waren das Stadium gemäß der International Federation of Gynecologists and Obstetricians, die Beckenwandbeteiligung und der CR-Status wichtige Faktoren für die PFS- oder OS-Raten. Die Inzidenz schwerer akuter und später auftretender Toxizitäten (≥Grad 3) betrug 12,1 % bzw. 3,0 %.

Schlussfolgerung

Die aggressive Salvage-RT mit oder ohne begleitende Chemotherapie für ein auf die Beckenhöhle begrenztes rezidivierendes Zervixkarzinom ist praktikabel, mit vielversprechenden Behandlungsergebnissen und akzeptablen Toxizitäten. Für Patientinnen mit ungünstigen prognostischen Faktoren sollten intensiver neuartige Behandlungsstrategien untersucht werden.

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Authors and Affiliations

  1. Department of Radiation Oncology, Ajou University School of Medicine, 164 Worldcup-ro, 16499, Yeongtong-gu, Suwon, Gyeonggi-do, Republic of Korea

    Sang-Won Kim MD, Mison Chun MD, PhD & Young-Taek Oh MD, PhD

  2. Department of Obstetrics and Gynecology, Ajou University School of Medicine, 164 Worldcup-ro, 16499, Yeongtong-gu, Suwon, Gyeonggi-do, Republic of Korea

    Hee-Sug Ryu MD, PhD, Suk-Joon Chang MD, PhD & Tae Wook Kong MD

  3. Department of Radiology, Ajou University School of Medicine, 164 Worldcup-ro, 16499, Yeongtong-gu, Suwon, Gyeonggi-do, Republic of Korea

    Eun Ju Lee MD, PhD

  4. Department of Pathology, Ajou University School of Medicine, 164 Worldcup-ro, 16499, Yeongtong-gu, Suwon, Gyeonggi-do, Republic of Korea

    Yong Hee Lee MD, PhD

  5. Department of Radiation Oncology, Konyang University School of Medicine, Daejeon, Republic of Korea

    Sang-Won Kim MD

Authors
  1. Sang-Won Kim MD
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  2. Mison Chun MD, PhD
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  3. Hee-Sug Ryu MD, PhD
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  4. Suk-Joon Chang MD, PhD
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  5. Tae Wook Kong MD
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  6. Eun Ju Lee MD, PhD
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  7. Yong Hee Lee MD, PhD
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  8. Young-Taek Oh MD, PhD
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Corresponding author

Correspondence to Mison Chun MD, PhD.

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Conflict of interest

S.-W. Kim, M. Chun, H.-S. Ryu, S.-J. Chang, T.W. Kong, E.J. Lee, Y.H. Lee, and Y.-T. Oh declare that they have no competing interests.

Ethical standards

This study was performed in accordance with the guidelines of the institutional review board, which waived the requirements of informed consent due to the retrospective nature of this study.

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Kim, SW., Chun, M., Ryu, HS. et al. Salvage radiotherapy with or without concurrent chemotherapy for pelvic recurrence after hysterectomy alone for early-stage uterine cervical cancer. Strahlenther Onkol 193, 534–542 (2017). https://doi.org/10.1007/s00066-017-1122-0

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  • DOI: https://doi.org/10.1007/s00066-017-1122-0

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