title: Details of recurrence sites after definitive radiation therapy for cervical cancer.
abstract: OBJECTIVE
  This is a retrospective study aimed at clarifying the details of recurrence patterns and sites in patients with cervical cancer treated with definitive radiation therapy (RT).
  
  
  METHODS
  Data were analyzed from consecutive patients, admitted to the University of Tokyo Hospital (Tokyo, Japan) between 2001 and 2013, who had received definitive RT, with or without chemotherapy, for International Federation of Gynecology and Obstetrics stages IB-IVA cervical cancer.
  
  
  RESULTS
  One hundred and thirty-seven patients formed the patient cohort. The median follow-up period for surviving patients was 57.0 months. A complete response was achieved in 121 patients (88%). Of these, 36 (30%) developed a cancer recurrence during follow-up. The first sites of recurrence were located in intra-RT fields in nine, outside RT fields in 20, and both in seven patients. In the intra-RT field group, all patients showed a local recurrence, while no one experienced an isolated pelvic lymph node (PLN) recurrence. In the outside RT field group, the most frequent site of recurrence was lung (60%), and three-quarters of patients were free from intra-RT field recurrence until the last follow-up. Of the entire cohort, including 48 PLN-positive patients, only seven patients (5.1%) developed PLN persistence or recurrence, all in the common iliac, internal iliac, and/or obturator nodes, and all with another synchronous relapse.
  
  
  CONCLUSIONS
  Local disease was a major type of intra-RT field recurrence, while PLN control was favorable even in initially PLN-positive patients. The predominance of outside RT field recurrence alone highlights issues concerning distant control, including the intensity enhancement of systematic therapy.
authors.affiliation: Department of Radiology, University of Tokyo Graduate School of Medicine, Tokyo, Japan.
authors.forename: Reiko
authors.identifier: http://orcid.org/0000-0003-3081-5588
authors.initials: R
authors.lastname: Kobayashi
authors.affiliation: Department of Radiology, University of Tokyo Graduate School of Medicine, Tokyo, Japan. yamachan07291973@yahoo.co.jp.
authors.forename: Hideomi
authors.identifier: http://orcid.org/0000-0001-9394-9490
authors.initials: H
authors.lastname: Yamashita
authors.affiliation: Department of Radiology, University of Tokyo Graduate School of Medicine, Tokyo, Japan.
authors.forename: Kae
authors.identifier: http://orcid.org/0000-0003-3284-7110
authors.initials: K
authors.lastname: Okuma
authors.affiliation: Department of Radiology, University of Tokyo Graduate School of Medicine, Tokyo, Japan.
authors.forename: Kuni
authors.identifier: http://orcid.org/0000-0003-3332-854X
authors.initials: K
authors.lastname: Ohtomo
authors.affiliation: Department of Radiology, University of Tokyo Graduate School of Medicine, Tokyo, Japan.
authors.forename: Keiichi
authors.identifier: http://orcid.org/0000-0002-5874-8703
authors.initials: K
authors.lastname: Nakagawa
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy / Q000532:radiotherapy* / Q000556:secondary; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001918:Brachytherapy; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy / Q000532:radiotherapy* / Q000556:secondary; D059248:Chemoradiotherapy; D018572:Disease-Free Survival; D019583:Dose Fractionation, Radiation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000556:secondary*; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis*; D010388:Pelvis; D012189:Retrospective Studies; D015996:Survival Rate; D002583:Uterine Cervical Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy*
chemical_list: D000970:Antineoplastic Agents
keywords: Radiation Therapy; Recurrence; Uterine Cervical Neoplasms