Results of salvage radiotherapy after inadequate surgery in invasive cervical carcinoma patients: a retrospective analysis.
OBJECTIVE
To evaluate the results of salvage radiotherapy (RT) after inadequate surgery in patients with invasive carcinoma of the cervix.


METHODS
Between 1996 and 2001, 105 invasive cervical carcinoma patients were treated at our center with external beam RT with or without intracavitary RT after having undergone total/subtotal hysterectomy at outside institutions.


RESULTS
The median follow-up was 34 months. The gap between surgery and RT was 23-198 days (median, 80). Clinically visible residual disease was present in 81 patients (77.1%). Total hysterectomy had been done in 82 patients (78%) and subtotal hysterectomy in 23 patients (22%). The 5-year overall survival, disease-free survival, and pelvic control rates of all patients were 55.2%, 53.3%, and 72.4%, respectively. On univariate analysis, older age, total hysterectomy, hemoglobin level >10 g% before RT, nonsquamous histologic type, use of intracavitary RT, a shorter gap between surgery and RT, and the absence of, or a small volume of, residual disease favorably affected the outcome. The 5-year actuarial rate of late toxicity (Radiation Therapy Oncology Group Criteria) was 19% in the rectum, 4.8% in the bladder, 24.8% in the skin, and 14.3% in the small intestine.


CONCLUSIONS
Inadequate and inappropriate surgery in invasive cervical cancer with resulting gross residual disease is common in India. Factors such as the use of intracavitary RT, the correction of anemia, and a shorter gap between surgery and RT will enable postoperative RT to achieve acceptable results with minimal morbidity.
Saibishkumar
Elantholi P
EP
Department of Radiotherapy, Post Graduate Institute of Medical Education and Research, Chandigarh, India. drsaibish@rediffmail.com
Patel
Firuza D
FD
Ghoshal
Sushmita
S
Kumar
Vinay
V
Karunanidhi
Gunaseelan
G
Sharma
Suresh C
SC
D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D001918:Brachytherapy; D003037:Cobalt Radioisotopes / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods; D008875:Middle Aged; D018365:Neoplasm, Residual; D011832:Radiation Injuries / Q000209:etiology; D012189:Retrospective Studies; D016879:Salvage Therapy; D016019:Survival Analysis; D002583:Uterine Cervical Neoplasms / Q000532:radiotherapy* / Q000601:surgery
D003037:Cobalt Radioisotopes