Abstract：Objective To analyze the long-term efficacy and adverse effects of radiotherapy in the treatment of recurrent lesions at the vaginal cuff after hysterectomy for cervical cancer, and to investigate prognostic factors. Methods A total of 105 patients who were admitted to our hospital due to recurrent lesions at the vaginal cuff after hysterectomy for cervical cancer from January 2005 to July 2011 were enrolled in this study and divided into group A (6-12 months), group B (12-24 months), and group C (≥24 months) according to the time to recurrence. All patients received radiotherapy and only 96 patients also received concurrent chemotherapy. The long-term outcomes and adverse events were compared between the three groups, and the prognostic factors were analyzed. Survival curves were analyzed by the Kaplan-Meier method. Results The follow-up rate was 98.1%. The response rates of group A, B, and C were 60%, 82%, and 86%, respectively. The 3-and 5-year survival rates for all patients were 58.1% and 31.4%, respectively. The median survival time for all patients was 42 months. Group C had a significantly longer median survival time than group A (P=0.010). The patients with a maximum tumor diameter of<4 cm had a significantly better treatment outcome than those with a maximum tumor diameter of ≥4 cm (P=0.000). There was a significant difference in median survival time between the patients with recurrent lesions limited to the vaginal cuff and those with recurrent lesions beyond the vaginal cuff (47 months vs. 32 months, P=0.005). Conclusions For patients with recurrent lesions at the vaginal cuff after hysterectomy for cervical cancer, radiotherapy is a salvage treatment and has significant clinical efficacy. The treatment outcome and prognosis are related to time to recurrence, tumor size, and the extent of recurrent lesions.
Li Huiling,Lin Xian,Chen Wenjuan et al. Clinical efficacy of radiotherapy in treatment of recurrent lesions at vaginal cuff after hysterectomy for cervical cancer[J]. Chinese Journal of Radiation Oncology, 2017, 26(9): 1028-1032.
[1] Lee YS,Kim YS,Kim JH,et al. Feasibility and outcome of concurrent chemoradiotherapy for recurrent cervical carcinoma after initial surgery[J].Tumori,2010,96(4):553-559. [2] DiSaia PJ,Creasman WT.Clinical gynecologic oncology[M].6th ed. Amsterdam:Elsevier science,2002:89-104. [3] Abe A,Matoda M,Okamoto S,et al. Resection of the vaginal vault for vaginal recurrence of cervical cancer after hysterectomy and brachytherapy[J]. World J Surg Oncol,2015,13(1):137.DOI:10.1186/s12957-015-0495-8. [4] Leitao MM,Chi DS.Recurrent cervical cancer[J].Curr Treat Options Oncol,2002,3(2):105-111.DOI:10.1007/s11864-002-0056-6. [5] Markman M.Chemoradiation in the management of cervix cancer:current status and future directions[J].Oneology, 2013,84(4):246-250.DOI:10.1159/000346804. [6] Thanagumtorn K.Survival rate of recurrent cervical carcinoma[J].J Med Assoc Thai,2012,95 Suppl 3:S125-S130. [7] Gadducci A,Tana R,Cosio S,et al. Treatment options in recurrent cervical cancer (Review)[J].Oncol Lett,2010,1(1):3-11. DOI:10.3892/ol_00000001. [8] Charra C,Roy P,Coquard R,et al. Outcome of treatment of upper third vaginal recurrences of cervical and endometrial carcinomas with interstitial brachytherapy[J].Int J Radiat Oncol Biol Phys,1998,40(2):421-426.DOI:10.1016/ S0360-3016(97)00576-2. [9] Ito H,Shigematsu N,Kawada T,et al. Radiotherapy for centrally recurrent cervical cancer of the vaginal stump following hysterectomy[J].Gynecol Oncol,1997,67(2):154-161.DOI:10. 1006/gyno.1997.4855. [10] D′Souza WD,Ahamad AA,Iyer RB,et al. Feasibility of dose escalation using intensity-modulated radiotherapy in posthysterectomy cervical carcinoma[J].Int J Radiat Oncol Biol Phys,2005,61(4):1062-1070.DOI:10.1016/j.ijrobp. 2004.07.721. [11] 潘翠金.介入化学治疗在复发宫颈癌中的应用[J].微创医学,2011,6(2):148-149.DOI:10.3969/j.issn.1673-6575.2011.02.028. Pan CJ.Application of interventional chemotherapy in recurrent cervical cancer[J].MinInvas Med,2011,6(2):148-149. DOI:10.3969/j.issn.1673-6575.2011.02.028. [12] 杨运胜,高国兰.介入化学治疗加放射治疗在Ⅲ b期宫颈癌治疗作用的探讨[J].江西医学,2005,40(11):738-739.DOI:10. 3969/j.issn.1006-2238.2005.11.030. Yang YS,Gao GL.Interventional chemotherapy plus radiotherapy in the treatment of stage Ⅲ b cervical cancer[J].Jiangxi Med,2005,40(11):738-739.DOI:10.3969/j. issn. 1006-2238.2005.11.030. [13] 张玉勤,俞绍音,王华英.宫颈癌手术治疗后阴道残端复发灶的放射治疗[J].中国癌症杂志,2000,10(3):250-252.DOI:10. 3969/j.issn.1007-3639.2000.03.021. Zhang YQ,Yu SY,Wang HY.Radiotherapy for centrally recurrent cervical cancer of the vaginal stump following primary surgery[J].China Oncol,2000,10(3):250-252.DOI:10.3969/ j.issn.1007-3639.2000.03.021. [14] Ijaz T,Eifel PJ,Burke T,et al. Radiation therapy of pelvic recurrence after radical hysterectomy for cervical carcinoma[J].Gynecol Oncol,1998,70(2):241-246.DOI:10. 1006/gyno.1998.5093. [15] Jain P, Hunter RD, Livsey JE, et al. Salvaging locoregional recurrence with radiotherapy after surgery in early cervical cancer[J]. Clin Oncol, 2007, 19(10):763-768. DOI:10.1016/j.clon.2007.08.015. [16] Bialas B,Kellas-Sleczka S,Fijalkowski M,et al. Tolerance and efficacy of preoperative intracavitary HDR brachytherapy in IB and ⅡA cervical cancer[J].J Contemp Brachytherapy,2009, 1(1):38-44. [17] Milutin B,Jovan B,Zoran K.Rectal dosimetry in intracavitary applications of cervix carcinoma:comparison of two methods[J].Arch Oncol,2002,10(4):253-259.DOI:10.2298/ AOO0204253B.
2017, Vol. 26 
