Introduction/Background Posttreatment isolated central rest of the cervical tumor (Tu), after definitive radiotherapy (RT) or concomitant chemoiradiation (CCRT) with cisplatin-based chemotherapeutic potentiation (HT CDDP), occurs in only 2–3% of patients.¹ Adequate operative approach (hysterectomy with bilateral adnexectomy of different radicality), is a treatment of choice.^2–4 HT and reirradiation have modest results.³ Monitoring (wait and watch) can be a choice in selected patients.⁵

Objective Analysis of the clinical-diagnostic approach and overall survival (OS) of patients with MR isolated central rest-recurrence of cervical tumor.

Methodology We analized data from 30 patients with MR-verified isolated central rest/recurrence of cervical cancer after definitive RT/CCRT, treated on IORS. Kaplan-Meyer method was used to analyze overall survival. Wilcoxon rank-sum and Fisher exact tests were applied to examine differences between subgroups of interest.

Results Isolated central rest/recurrence was verified in 30 patients by post-therapeutic MR imaging, PET/CT was performed in 7 patients and showed significantly elevated SUVmax value, with suspicion of the presence of rest/recurrent Tu. PH verification of rest/recurrence was conducted in only 3 patients the result of necrosis without signs of malignancy. In the further procedure, 17 patients underwent hysterectomy with bilateral adnexectomy, 2 received chemotherapy, and, a clinical follow-up approach was conducted in 11 patients, with MR imaging and intensive local care. In a subgroup of operated patients, the presence of malignancy was PH confirmed in 8 patients. In the whole group, the average survival was 98 months (range 6–190 months).

Conclusion An individual multimodal approach is necessary in case of isolated central rest/recurrence of cervical cancer. MR and PET/CT imaging are the methods of choice, with limitations in a situation of postiradiation necrosis and the impossibility of biopsy PH verification. Adjuvant hysterectomy with adnexectomy is an effective treatment option that can achieve a cure, but potential complications should be considered.

References

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2. Ota T, Takeshima N, Tabata T, Hasumi K, Takizawa K. Adjuvant hysterectomy for treatment of residual disease in patients with cervical cancer treated with radiation therapy. Br J of Cancer. 2008;99(8):1216–1220.

3. Friedlander M, Grogan M. Guidelines for the treatment of recurrent and metastatic cervical cancer. Oncologist. 2002;7:342–347.

4. Hong J, Tsai C, Lai C, Chang T, Wang C, Chou H, Hsueh S. Recurrent squamous cell carcinoma of cervix after definitive radiotherapy. Int J Radiat Oncol Biol Phys. 2004;60(1):249–257.

5. Fawaz ZS, Barkati M, Beauchemin MC, et al. Cervical necrosis after chemoradiation for cervical cancer: case series and literature review. Radiat Oncol 2013;8:220.