[Isolated pelvic recurrences of cervical carcinoma treated with salvage chemoradiotherapy]

Abstract

Purpose: Evaluation of the results of salvage radiation therapy with curative intent in the treatment of recurrent cervical carcinoma.

Patients and methods: Fourteen patients with a recurrence of a cervical cancer were treated in our department between 1982 and 2009. Five patients had a pelvic relapse, four a vaginal relapse and five a pelvic lymph node relapse. Four patients had first a surgical resection of the relapse, which was incomplete in two patients. All patients had pelvic radiotherapy with a median dose of 55Gy in conventional fractionation. Concurrent chemotherapy was administered to 12 patients. A vaginal brachytherapy with a median dose of 20Gy was performed in addition in 3 patients. The median follow-up was 39months.

Results: Safety of radiation therapy was correct with 29% of grade 3 acute or intestinal toxicity. Tumor control was observed in 10 patients (71%). Four patients presented a locoregional tumor progression. At the time of analysis, three patients had died from their cancer. From the date of relapse, the rate of overall survival at 2 and 5year was respectively 84% and 74%. Three patients (21%) had severe late effects.

Conclusion: In our experience, chemoradiotherapy can achieve a high rate of remission in patients with isolated pelvic recurrence of cervical cancer. This treatment is feasible only if the patient had not received radiation therapy before or if the relapse is out of the previously irradiated volume.

Keywords: Brachytherapy; Cancer du col utérin; Cervix carcinoma; Curiethérapie; Pelvic relapse; Radiation therapy; Radiothérapie; Rechute pelvienne; Toxicité.