Background

Detection of residual tumor after radio-chemotherapy(RCX) in patients with locally advanced cervical cancer creates problems in clinical management. The aim of study is to evaluate the survival effect and prognostic importance of the residual tumor limited to the uterus in patients with advanced cervical cancer who received primary RCX.

Methods

125 cases of inoperable cervix cancer applied to our clinic between June 2012 and December 2018. Patients undergo magnetic resonance imaging of the pelvis to evaluate residual tumor before brachytherapy treatment, and positron emulsion tomography (PET-CT) to evaluate treatment response at 6 months after radical treatment.

Results

The median age was 50 and 111 patients (88.8% were diagnosed with squamous cell carcinoma and 14(11.2% with adenocarcinoma. Median tumor size was 5 cm and 71 patients were stage IIB (56.8%, and lymphnodes(LN) were detected in PET-CT before treatment in 70 patients. Residual tumor was found in 47 patients (37.6% median follow-up after external RCX 45 months (7-91) , and in 10 patients at 6 months.Three-year overall survival (OS), local recurrence-free survival (LRFS), and distant metastasis-free survival (DMFS) rates were 86.9%, 89.1%, and 76.4%, respectively. In the univariate analysis, it was seen that the presence of residual tumor detected at 6 months was an unfavorable prognostic factor on LRFS (p=0.01), OS (p=0.001), and DMFS (p=0.01.Pre-treatment evaluation, presence of pelvic LN in PET-CT (p=0.05) and detection of residual tumor after external pelvic radiotherapy (p=0.015) were unfavorable prognostic factors on LRFS and DMFS.Local control (LC) was better in patients < 60 years (p=0.001), and distant metastases were more common in tumors > 5 cm (p=0.02. LC was better in <60 years (p=0.001), and distant metastases were more common in > 5 cm (p=0.02. Presence of residual tumor on PET-CT 6 months after treatment was determined in multivariate analysis as an important prognostic factor on OS and LRFS.

Conclusions

Treatment is controversial in patients with residual tumor after RCX.. Survival is worse in patients with residual tumor at 6-month follow-ups after treatment. The need for adjuvant therapy should be considered in these patients.

Editorial acknowledgement

Bedriye Doğan¹, Özlem Yetmen Doğan¹, Makbule Doğan Eren¹, Evrim Amodor²

¹Istanbul Kartal Dr Lutfi Kırdar City Hospital, Radiation Oncology Department

²Istanbul Kartal Dr Lutfi Kırdar City Hospital, Nuclear Medicine Department