title: Time course and outcome of central recurrence after radiation therapy for carcinoma of the cervix.
abstract: We investigated the time course of central disease recurrence (CDR) in 2997 patients treated with radiation for stage I-II squamous cell carcinoma of the cervix. CDR rates were 6.8%, 7.8%, and 9.6%, at 5, 10, and 20 years, respectively. The risk of CDR was independently correlated with tumor size (P < 0.0001) but not with FIGO stage. The hazard rate peaked in the first year of follow-up and then fell steeply; after 3 years, the hazard rate was approximately constant at 0.2-0.4% per year. Although after 3 years the risk of CDR was low, it continued to be slightly greater for patients with tumors > or =5 cm than for those with smaller tumors (P= 0.001). Patients who had CDR < 36 months after treatment were less likely to be candidates for salvage therapy and had a poorer post-recurrence survival rate than those with recurrence > or =36 months after treatment (4.5% versus 42.1%, P < 0.0001). The higher rate of CDR in the first 3 years and the poor survival after early recurrence suggest that most early CDRs are true relapses. The relatively stable annual actuarial risk between 3 and 25 years and the better survival rate after late CDR suggest that most "recurrences" after 3 years are actually new neoplasms.
authors.affiliation: Department of Radiation Oncology, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA. peifel@mdanderson.org
authors.forename: P J
authors.initials: PJ
authors.lastname: Eifel
authors.forename: A
authors.initials: A
authors.lastname: Jhingran
authors.forename: J
authors.initials: J
authors.lastname: Brown
authors.forename: C
authors.initials: C
authors.lastname: Levenback
authors.forename: H
authors.initials: H
authors.lastname: Thames
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000379:methods; D002294:Carcinoma, Squamous Cell / Q000453:epidemiology / Q000401:mortality / Q000532:radiotherapy; D003131:Combined Modality Therapy / Q000379:methods; D005260:Female; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology* / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D016879:Salvage Therapy / Q000379:methods / Q000706:statistics & numerical data; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology / Q000401:mortality / Q000532:radiotherapy*