title: Salvaging locoregional recurrence with radiotherapy after surgery in early cervical cancer.
abstract: OBJECTIVE
  To determine the outcome and morbidity after radiotherapy for locally recurrent cervical cancer.
  
  
  METHODS
  Women who presented with locally recurrent cervical cancer after surgery alone during 1985 and 1997 were identified from the hospital database. Data were collected and analysed to include the stage at first diagnosis, staging investigations before surgery, the surgical procedure, the indication for radiotherapy, the type of radiotherapy, morbidity and survival.
  
  
  RESULTS
  In total, 130 women had radical external beam radiotherapy and/or intracavitary brachytherapy for locoregional recurrence during the defined study period. The 5-year disease-specific survival for the study population was 40.2%. Women who were treated for vault recurrence had a significantly better 5-year disease-free survival compared with women who developed nodal recurrence alone (55.4% vs 12.5%). This group of women also had a significantly slower rate of disease progression after radiotherapy than women with nodal recurrence (48.7% vs 87.5%, P=0.0001).
  
  
  CONCLUSIONS
  Radical radiotherapy alone is able to salvage 55% of vaginal vault recurrences after surgery for cervical cancer with minimal late toxicity. Salvage rates in women with pelvic nodal recurrences are considerably lower. Chemoradiotherapy using intensity-modulated radiotherapy to deliver an escalated radiotherapy dose needs to be pursued to improve locoregional control.
authors.affiliation: Clinical Oncology, Christie Hospital NHS Trust, Manchester, UK. pooja.jain@christie.nhs.uk
authors.forename: P
authors.initials: P
authors.lastname: Jain
authors.forename: R D
authors.initials: RD
authors.lastname: Hunter
authors.forename: J E
authors.initials: JE
authors.lastname: Livsey
authors.forename: C
authors.initials: C
authors.lastname: Coyle
authors.forename: R
authors.initials: R
authors.lastname: Swindell
authors.forename: S E
authors.initials: SE
authors.lastname: Davidson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000379:methods; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007044:Hysterectomy; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000532:radiotherapy*; D012189:Retrospective Studies; D016879:Salvage Therapy; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000532:radiotherapy* / Q000601:surgery*