title: Salvage stereotactic body radiotherapy for locally recurrent uterine cervix cancer at the pelvic sidewall: Feasibility and complication.
abstract: OBJECTIVE
  To determine the feasibility of stereotactic body radiotherapy (SBRT) in patients with pelvic sidewall recurrence of uterine cervical cancer after radical hysterectomy or definitive radiotherapy.
  
  
  METHODS
  We retrospectively reviewed 23 patients with locally recurrent uterine cervical cancer limited to the pelvic sidewall who were treated with SBRT at our institution between January 2003 and May 2010. The SBRT dose ranged from 27 to 45 Gy (median, 39 Gy) in three fractions, and the fractional SBRT dose ranged from 9 to 15 Gy (median, 13 Gy).
  
  
  RESULTS
  The 2-year overall survival, local progression-free survival and disease progression-free survival rates were 43%, 65% and 52%, respectively. Patients with small tumors (gross tumor volume <30 cm(3) ) had a significantly longer 2-year overall survival rate and 2-year local progression-free survival rate than did patients with large tumors (overall survival rate: 89% vs 12%; P = 0.0001 and local progression-free survival: 85% vs 0%; P = 0.0199). There were three cases (13%) of severe toxicities (rectovaginal fistula). Pelvic pain relief was achieved in all patients. In particular, 10 of 14 patients (71%) achieved analgesic (nonsteroidal anti-inflammatory drug or narcotic) reduction of 50% or more from baseline.
  
  
  CONCLUSIONS
  SBRT is a feasible treatment option for women with pelvic sidewall tumors from recurrent uterine cervical cancer, especially for small recurrent tumors. However, SBRT should be used carefully in the treatment of large tumors, as the incidence of severe late toxicity increases with the size of the tumor.
authors.affiliation: Department of Radiation Oncology, Korea Institute of Radiological & Medical Sciences, Seoul, Korea.
authors.forename: YoungSeok
authors.identifier: http://orcid.org/0000-0002-9329-8699
authors.initials: Y
authors.lastname: Seo
authors.affiliation: Department of Radiation Oncology, Korea Institute of Radiological & Medical Sciences, Seoul, Korea.
authors.forename: Mi-Sook
authors.initials: MS
authors.lastname: Kim
authors.affiliation: Department of Radiation Oncology, Korea Institute of Radiological & Medical Sciences, Seoul, Korea.
authors.forename: Hyung-Jun
authors.initials: HJ
authors.lastname: Yoo
authors.affiliation: Department of Radiation Oncology, Korea Institute of Radiological & Medical Sciences, Seoul, Korea.
authors.forename: Won-Il
authors.initials: WI
authors.lastname: Jang
authors.affiliation: Department of Gynecology, Korea Institute of Radiological & Medical Sciences, Seoul, Korea.
authors.forename: Sang-Young
authors.initials: SY
authors.lastname: Rhu
authors.affiliation: Department of Gynecology, Korea Institute of Radiological & Medical Sciences, Seoul, Korea.
authors.forename: Suck-Chul
authors.initials: SC
authors.lastname: Choi
authors.affiliation: Department of Gynecology, Korea Institute of Radiological & Medical Sciences, Seoul, Korea.
authors.forename: Moon-Hong
authors.initials: MH
authors.lastname: Kim
authors.affiliation: Department of Gynecology, Korea Institute of Radiological & Medical Sciences, Seoul, Korea.
authors.forename: Beob-Jong
authors.initials: BJ
authors.lastname: Kim
authors.affiliation: CyberKnife Center, Korea Institute of Radiological & Medical Sciences, Seoul, Korea.
authors.forename: Dong-Han
authors.initials: DH
authors.lastname: Lee
authors.affiliation: Department of Radiation Oncology, Korea Institute of Radiological & Medical Sciences, Seoul, Korea.
authors.forename: Chul-Koo
authors.initials: CK
authors.lastname: Cho
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018572:Disease-Free Survival; D004307:Dose-Response Relationship, Radiation; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007044:Hysterectomy; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000601:surgery*; D016634:Radiosurgery / Q000379:methods*; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000379:methods; D015996:Survival Rate; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*
keywords: recurrent; stereotactic radiotherapy; uterine cervix cancer