J Gynecol Oncol.  2012 Jul;23(3):168-174. 10.3802/jgo.2012.23.3.168.

Salvage radiotherapy for lymph node recurrence after radical surgery in cervical cancer

• Jeon W
• Koh HK
• Kim HJ
• Wu HG
• Kim JH
• Chung HH

• KMID: 2245175
• DOI: http://doi.org/10.3802/jgo.2012.23.3.168

Abstract

OBJECTIVE
This study was to evaluate the treatment outcomes and prognostic factors of patients treated with salvage radiotherapy for the treatment of isolated lymph node recurrence of cervical cancer.
METHODS
Between 1990 and 2009, 22 cervical cancer patients with lymph node recurrence who had previously undergone radical hysterectomy and pelvic lymph node dissection were treated with salvage radiotherapy with (n=18) or without (n=4) chemotherapy. Of the 22 patients, 10 had supraclavicular lymph node recurrence, 9 had para-aortic lymph node, and 3 had inguinal lymph node. The median total radiotherapy dose was 60 Gy (range, 40 to 70 Gy). Initial pathologic findings, latent period to lymph node recurrence and other clinical parameters such as squamous cell carcinoma antigen (SCC-Ag) level and concurrent chemotherapy were identified as prognostic factors for survival.
RESULTS
The median follow-up period after salvage radiotherapy was 31.2 months (range, 12.1 to 148.9 months). The 5-year progression-free and overall survival rates of all patients were 32.7% and 30.7%, respectively. Concurrent chemoradiotherapy (p=0.009) and longer latent period to lymph node recurrence (>18 months vs. < or =18 months, p=0.019) were significant predictors of progression-free survival and SCC-Ag level at the time of recurrence (>8 ng/dL vs. < or =8 ng/dL, p=0.008) and longer latent period to lymph node recurrence (p=0.040) for overall survival. Treatment failure after salvage radiotherapy occurred in 14 (63.6%) for the 22 patients (in field, 2; out of field, 10; both in and out field, 2). Grade 3 acute skin (n=2) and hematologic toxicity (n=1) developed in 3 patients.
CONCLUSION
For isolated lymph node recurrence of cervical cancer, salvage radiotherapy with concurrent chemotherapy should be considered, especially in patients with a long-term progression-free period.

Keyword

Cervical cancer; Lymph nodes; Salvage therapy

MeSH Terms

Antigens, Neoplasm
Carcinoma, Squamous Cell
Chemoradiotherapy
Disease-Free Survival
Follow-Up Studies
Humans
Hysterectomy
Lymph Node Excision
Lymph Nodes
Recurrence
Salvage Therapy
Serpins
Skin
Survival Rate
Treatment Failure
Uterine Cervical Neoplasms
Antigens, Neoplasm
Serpins

Figure

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  Fig. 1 Progression-free and overall survival of no evidence of disease (NED) >18 months and concurrent chemoradiotherapy (CCRT) group.

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