Clinical outcome of recurrent locally advanced cervical cancer (LACC) submitted to primary multimodality therapies.
OBJECTIVE
Recurrence of disease represents a clinical challenge in cervical cancer patients, especially when all available treatment modalities have been used in the primary setting. The aim of this study was to analyze the patterns of recurrence and their association with clinical outcome in locally advanced cervical cancer (LACC) patients submitted to primary chemoradiation (CTRT) followed by radical surgery (RS).


METHODS
This study was conducted on 364 LACC patients treated with CTRT plus RS since January 1996 to July 2012. For each relapse, information on date of clinical/pathological recurrence, and pattern of disease presentation were retrieved. Post-relapse survival (PRS) was recorded from the date of recurrence to the date of death for disease or last seen. Survival probabilities were compared by the log rank test. Cox's regression model with stepwise variable selection was used for multivariate prognostic analysis for PRS.


RESULTS
Within a median follow-up of 42months, 75 recurrences (20.6%) and 54 disease-associated deaths (14.8%) were recorded. By analysing the pattern of relapse, most of the recurrences were outside the irradiated field (n=43, 57.3%) and the most frequently observed site was visceral (n=16, 21.3%). Among the parameters of the recurrence associated with PRS including the pattern of recurrence, the size of recurrence, SCC-Ag serum levels at recurrence, and secondary radical surgery, only the last one retained an independent predictive role in reducing the risk of death (p=0.037).


CONCLUSIONS
The feasibility of secondary radical resection positively impacts on PRS of LACC patients submitted to multimodality primary treatments.
Gynecologic Oncology Unit, "F. Miulli" General Regional Hospital, Acquaviva delle Fonti, Bari, Italy. Electronic address: francescolegge@libero.it.
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F
Legge
Gynecologic Oncology Unit, "Giovanni Paolo II" Foundation, Campobasso, Italy.
V
V
Chiantera
Department of Radiation Therapy, "Giovanni Paolo II" Foundation, Campobasso, Italy.
G
G
Macchia
Gynecologic Surgery Unit, University of Perugia, Perugia, Italy.
A
A
Fagotti
Gynecologic Oncology Unit, Catholic University, Rome, Italy.
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F
Fanfani
Gynecologic Oncology Unit, Policlinico Abano Terme, Abano Terme, Padua, Italy.
A
A
Ercoli
Gynecologic Oncology Unit, Catholic University, Rome, Italy.
V
V
Gallotta
Department of Radiation Therapy, "Giovanni Paolo II" Foundation, Campobasso, Italy.
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AG
Morganti
Department of Radiation Therapy, Catholic University, Rome, Italy.
V
V
Valentini
Gynecologic Oncology Unit, Catholic University, Rome, Italy.
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Scambia
Gynecologic Oncology Unit, Catholic University, Rome, Italy.
G
G
Ferrandina
D000328:Adult; D059186:Chemoradiotherapy, Adjuvant; D005260:Female; D006801:Humans; D020360:Neoadjuvant Therapy; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000628:therapy*; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000601:surgery / Q000628:therapy*
Chemoradiation; Post-relapse survival; Prognosis; Radical hysterectomy; Recurrent cervical cancer