title: Follow-up for women after treatment for cervical cancer: a systematic review.
abstract: OBJECTIVE
  To determine the optimal recommended program for the follow-up of patients who are disease free after completed primary therapy for cervical cancer.
  
  
  METHODS
  Systematic search of MEDLINE, EMBASE and the Cochrane Library databases (1980-November 2007).
  
  
  RESULTS
  Seventeen retrospective trials were identified. Most studies reported similar intervals for follow-up and ranged from a low of 9 visits to a high of 28 visits over 5 years. Follow-up visits typically occurred once every 3-4 months for the first 2 years, every 6 months for the next 3 years and then annually until year 10. All 17 trials reported that a physical exam was performed at each visit. Vaginal vault cytology was analyzed in 13 trials. Other routine surveillance tests included chest x-ray, ultrasound, CT scans, MRI, intravenous pyelography and tumour markers. Median time to recurrence ranged from 7-36 months after primary treatment. Rates of recurrence ranged from 8-26% with 14-57% of patients recurring in the pelvis, and 15-61% of patients recurring at distant or multiple sites. Of the 8-26% of patients who experienced disease recurrence, the vast majority, 89-99%, had recurred by year 5. Upon recurrence, median survival was 7-17 months. Asymptomatic recurrent disease was detected using physical exam in 29-71%, chest x-ray in 20-47%, CT in 0-34% and vaginal vault cytology in 0-17% of patients, respectively.
  
  
  CONCLUSIONS
  There is modest low quality evidence to inform the most appropriate follow-up strategy for patients with cervical cancer who are clinically disease free after receiving primary treatment. Follow-up visits should include a complete physical examination whereas, frequent vaginal vault cytology does not add significantly to the detection of early disease recurrence. Patients should return to annual population-based screening after 5 years of recurrence-free follow-up.
authors: Juravinski Regional Cancer Centre, Hamilton, ON, Canada.
authors: Laurie
authors: L
authors: Elit
authors: Anthony W
authors: AW
authors: Fyles
authors: Michaela C
authors: MC
authors: Devries
authors: Thomas K
authors: TK
authors: Oliver
authors: Michael
authors: M
authors: Fung-Kee-Fung
mesh_terms: D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D012189:Retrospective Studies; D002583:Uterine Cervical Neoplasms / Q000628:therapy*