Surgery followed by concurrent radiochemotherapy as treatment for patients with locally recurrent cervical cancer

Xiang Zhang; Zhongbo Chen; Jianhong Chen; Junjian Wang; Yingchang Wang; Jianqing Zhu

doi:10.21037/tcr-21-1163

Surgery followed by concurrent radiochemotherapy as treatment for patients with locally recurrent cervical cancer

Transl Cancer Res. 2021 Oct;10(10):4365-4374. doi: 10.21037/tcr-21-1163.

Authors

Xiang Zhang^{1

2}, Zhongbo Chen³, Jianhong Chen^{1

2}, Junjian Wang³, Yingchang Wang^{1

2}, Jianqing Zhu³

Affiliations

¹ Department of Gynecologic Radiation Oncology, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Cancer and Casic Medicine (IBMC), Chinese Academy of Science, Hangzhou, China.
² Zhejiang Key Laboratory of Radiation Oncology, Hangzhou, China.
³ Department of Gynecologic Surgery, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Cancer and Casic Medicine (IBMC), Chinese Academy of Science, Hangzhou, China.

Abstract

Background: No standard treatment exists for patients with recurrent cervical cancer. This study aimed to determine the role of surgery, followed by concurrent radiochemotherapy, as a treatment for recurrent pelvic cervical cancer without previous radiotherapy.

Methods: The current study identified patients diagnosed with vaginal and/or pelvic sidewall recurrent cervical cancer after primary surgery without radiotherapy in Zhejiang Cancer Hospital from May 2012 to November 2016. These enrolled patients underwent surgery, followed by concurrent radiochemotherapy and data were analyzed.

Results: This study enrolled 27 patients, including 11 with central (vaginal) and 16 with noncentral (pelvic sidewall with or without vaginal) recurrences. The median follow-up time after recurrence was 64 months (range, 5-110 months). All patients underwent surgery to resect the tumor as completely as possible and pelvic external beam radiotherapy (EBRT) with a median equivalent dose in 2 Gy fractions (EQD2) of 45.1 Gy (range, 44.3-47.8 Gy) with concurrent weekly cisplatin chemotherapy. The median EQD2 dose for the tumor bed/residual tumor was 51 Gy (range, 44.3-73.4 Gy), including 18 patients with a boost dose by EBRT or vaginal brachytherapy (VBT). The 5-year overall survival (OS) rates were 77.1% (central) and 65.7% (noncentral) without a statistically significant difference (P=0.246). Progression-free survival (PFS) rates were 81.8% (central) and 34.4% (noncentral), respectively, with a statistically significant difference (P=0.047). Three patients with noncentral recurrence experienced grade ≥3 complications associated with surgery.

Conclusions: Surgery followed by concurrent radiochemotherapy was a feasible and effective treatment with acceptable complications for locally recurrent cervical cancer, which markedly improved the survival of pelvic sidewall recurrence.

Keywords: Cervical cancer; radiochemotherapy; recurrent; surgery.