title: Salvage radiotherapy with or without concurrent chemotherapy for pelvic recurrence after hysterectomy alone for early-stage uterine cervical cancer.
abstract: OBJECTIVE
  Treatment outcomes of patients with pelvic recurrence after hysterectomy alone for uterine cervical cancer who received salvage radiotherapy (RT) with or without concurrent chemotherapy were investigated.
  
  
  METHODS
  Salvage RT for recurrent cervical cancer confined to the pelvic cavity after hysterectomy alone was received by 33 patients. The median interval between initial hysterectomy and recurrence was 26 months. Whole-pelvic irradiation was delivered to median dose of 45 Gy, followed by a boost with a median dose of 16 Gy to the gross tumor volume. Cisplatin-based concurrent chemotherapy was administered to 29 patients.
  
  
  RESULTS
  The median follow-up period was 53 months for surviving patients. Most patients (97.0%) completed salvage RT of ≥45 Gy. Complete response (CR) was achieved in 23 patients (69.7%). Pelvic sidewall involvement and evaluation with positron-emission tomography-computed tomography were significantly associated with CR. The 5‑year progression-free survival (PFS), local control (LC), distant metastasis-free survival (DMFS), and overall survival (OS) rates were 62.7, 79.5, 72.5, and 60.1%, respectively. Initial International Federation of Gynecology and Obstetrics stage, pelvic sidewall involvement, and CR status were significant factors for PFS and OS rates in multivariate analysis. The incidence of severe acute and late toxicities (≥grade 3) was 12.1 and 3.0%, respectively.
  
  
  CONCLUSIONS
  Aggressive salvage RT with or without concurrent chemotherapy for recurrent cervical cancer confined to the pelvic cavity was feasible, with promising treatment outcomes and acceptable toxicities. However, even more intensive novel treatment strategies should be investigated for patients with unfavorable prognostic factors.
authors.affiliation: Department of Radiation Oncology, Ajou University School of Medicine, 164 Worldcup-ro, 16499, Yeongtong-gu, Suwon, Gyeonggi-do, Republic of Korea.|Department of Radiation Oncology, Konyang University School of Medicine, Daejeon, Republic of Korea.
authors.forename: Sang-Won
authors.initials: SW
authors.lastname: Kim
authors.affiliation: Department of Radiation Oncology, Ajou University School of Medicine, 164 Worldcup-ro, 16499, Yeongtong-gu, Suwon, Gyeonggi-do, Republic of Korea. chunm@ajou.ac.kr.
authors.forename: Mison
authors.identifier: http://orcid.org/0000-0003-2334-3316
authors.initials: M
authors.lastname: Chun
authors.affiliation: Department of Obstetrics and Gynecology, Ajou University School of Medicine, 164 Worldcup-ro, 16499, Yeongtong-gu, Suwon, Gyeonggi-do, Republic of Korea.
authors.forename: Hee-Sug
authors.initials: HS
authors.lastname: Ryu
authors.affiliation: Department of Obstetrics and Gynecology, Ajou University School of Medicine, 164 Worldcup-ro, 16499, Yeongtong-gu, Suwon, Gyeonggi-do, Republic of Korea.
authors.forename: Suk-Joon
authors.initials: SJ
authors.lastname: Chang
authors.affiliation: Department of Obstetrics and Gynecology, Ajou University School of Medicine, 164 Worldcup-ro, 16499, Yeongtong-gu, Suwon, Gyeonggi-do, Republic of Korea.
authors.forename: Tae Wook
authors.initials: TW
authors.lastname: Kong
authors.affiliation: Department of Radiology, Ajou University School of Medicine, 164 Worldcup-ro, 16499, Yeongtong-gu, Suwon, Gyeonggi-do, Republic of Korea.
authors.forename: Eun Ju
authors.initials: EJ
authors.lastname: Lee
authors.affiliation: Department of Pathology, Ajou University School of Medicine, 164 Worldcup-ro, 16499, Yeongtong-gu, Suwon, Gyeonggi-do, Republic of Korea.
authors.forename: Yong Hee
authors.initials: YH
authors.lastname: Lee
authors.affiliation: Department of Radiation Oncology, Ajou University School of Medicine, 164 Worldcup-ro, 16499, Yeongtong-gu, Suwon, Gyeonggi-do, Republic of Korea.
authors.forename: Young-Taek
authors.initials: YT
authors.lastname: Oh
mesh_terms: D000328:Adult; D000368:Aged; D059248:Chemoradiotherapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007044:Hysterectomy; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D009367:Neoplasm Staging; D000072078:Positron Emission Tomography Computed Tomography; D011379:Prognosis; D057216:Propensity Score; D011879:Radiotherapy Dosage; D000069475:Re-Irradiation; D016879:Salvage Therapy; D015996:Survival Rate; D002583:Uterine Cervical Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*
keywords: Chemoradiotherapy; Neoplasm recurrence; Salvage therapy; Survival; Uterine cervical neoplasms