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1340 Central rest of cervical cancer after definitive RT/CCRT: clinical-diagnostic approach to decision making
  1. Mirjana Mikovic1,
  2. Aleksandar Tomaševic1,2,
  3. Brankica Rakovic1,
  4. Predrag Petrašinovic1,2,
  5. Marko Radovic1,
  6. Bojan Todorovic1,
  7. Aleksandar Pejcic1,
  8. Marina Grbic Ivancevic1 and
  9. Aleksandra Drinic1
  1. 1Institute for Oncology and Radiology of Serbia, IORS, Belgrade, Serbia
  2. 2University of Belgrade, Faculty of Medicine, Belgrade, Serbia


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.


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