title: Late recurrence of invasive cervical cancer: twenty years' experience in a single cancer institute.
abstract: OBJECTIVE
  To estimate the characteristics of, and prognosis for, late recurrence of cervical cancer.
  
  
  METHODS
  Between 1977 and 1996, of 1721 patients with invasive cervical cancer, 1157 survived more than 5 years. Twenty-eight patients whose cancer recurred after a disease-free interval of 5 years were retrospectively investigated. For 22 patients the cancer recurred after less than 10 years, for five patients it recurred between 10 and 20 years after the original occurrence, and in one patient the cancer recurred after more than 20 years.
  
  
  RESULTS
  The histologic subtypes included 20 squamous cell carcinomas and eight adenocarcinomas. The initial therapies were surgery alone (on one patient), surgery and adjuvant radiotherapy (on 20 of the patients) and radiotherapy alone (on seven of the patients). Recurrence was initially diagnosed by internal or external examination (11 patients), chest X-ray (six patients) and computed tomography (11 patients). Rates of lymphogenous metastases were 19% of patients with primary surgery and 57% of patients without primary surgery, while those of hematogenous metastases were 48% of patients with primary surgery and none of patients without primary surgery (P = 0.023). The overall survival rate after recurrence was 50.5% after 2 years and 22.3% after 5 years, respectively. Four of the patients survived for more than 3 years without evidence of disease; these patients all had recurrence outside the irradiated field and achieved complete remission with radiotherapy.
  
  
  CONCLUSIONS
  Late recurrence of cervical cancer was frequently observed in patients with initial treatment, including radiotherapy. Some had very long disease-free intervals, but many were diagnosed by ordinary internal or external examination or chest X-ray. Patients with primary surgery experienced recurrence less frequently in the case of lymph node metastasis than was the case for hematogenous metastasis. Radiotherapy was effective and improved prognosis, especially for recurrence of cancer outside the irradiated field.
authors.affiliation: Department of Gynecology, Saitama Cancer Center, Saitama, Japan. tgoto@saitama-med.ac.jp
authors.forename: Tomoko
authors.initials: T
authors.lastname: Goto
authors.forename: Nao
authors.initials: N
authors.lastname: Kino
authors.forename: Takako
authors.initials: T
authors.lastname: Shirai
authors.forename: Masaki
authors.initials: M
authors.lastname: Fujimura
authors.forename: Michiko
authors.initials: M
authors.lastname: Takahashi
authors.forename: Kenshi
authors.initials: K
authors.lastname: Shiromizu
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000556:secondary / Q000628:therapy; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000556:secondary / Q000628:therapy; D005260:Female; D006801:Humans; D007564:Japan; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D011379:Prognosis; D012189:Retrospective Studies; D013997:Time Factors; D002583:Uterine Cervical Neoplasms / Q000473:pathology* / Q000628:therapy