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Patterns of First Relapse and Outcome in Patients with Locally Advanced Cervical Cancer After Radiochemotherapy: A Single Institutional Experience

  • Ajay Sasidharan
  • Umesh M. MahantshettyEmail author
  • Lavanya Gurram
  • Supriya Chopra
  • Reena Engineer
  • Amita Maheshwari
  • Sudeep Gupta
  • Kedar Deodhar
  • Venkatesh Rangarajan
  • Meenakshi Thakur
  • Shyam Kishore Shrivastava
Original Article
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Abstract

Purpose

Radiochemotherapy followed by brachytherapy is the standard treatment in locally advanced cervical cancer. The aim of this study was to evaluate the patterns of first relapse, the treatment given and its outcome.

Methods

This is a retrospective analysis of electronic records of locally advanced cervical cancer patients treated in prospective trials from 2003 to 2014.

Results

Out of 1388 patients, relapse was seen in 316 (23%). Relapse was seen as—pelvic: 105 (7.6%), distant: 136 (10%), and both: 75 (5.4%). Local, regional, paraaortic and systemic relapses were seen in 148 (10.8%), 65 (4.7%), 102 (7.4%) and 163 (11.8%) patients, respectively. Post-relapse, 201/316 (63.6%) received palliative care alone. Treatment in the form of concurrent or sequential chemo-radiotherapy, surgery, stereotactic body radiotherapy and reirradiation using brachytherapy was received by 15 (4.7%), 7 (2.2%), 1 (0.3%) and 1(0.3%) patients, respectively; 65 (20.6%) received palliative chemotherapy, and 28 (8.9%) received palliative radiotherapy. Median post-relapse survival was 7 months (95% CI 5.9–8.1); and in those who received treatment versus supportive care was 10 (95% CI 7.0–13.0) versus 5 (95% CI 3.9–6.1) months (p < 0.001). The proportion of patients with > 1-year post-relapse survival was 85.7% in surgery, 66.7% in concurrent or sequential chemotherapy plus radiation, 32.3% in palliative chemotherapy, 14.3% in palliative radiotherapy and 13.4% in supportive care.

Conclusion

Distant failure is the predominant pattern of relapse seen in patients undergoing radiochemotherapy for locally advanced cervical cancer. Well-selected single-site relapses treated with surgery or chemotherapy plus radiation can have good post-relapse survival.

Keywords

Relapse Cervix Radiotherapy 

Notes

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

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Copyright information

© Association of Gynecologic Oncologists of India 2019

Authors and Affiliations

  • Ajay Sasidharan
    • 1
  • Umesh M. Mahantshetty
    • 1
    Email author
  • Lavanya Gurram
    • 1
  • Supriya Chopra
    • 1
  • Reena Engineer
    • 1
  • Amita Maheshwari
    • 2
  • Sudeep Gupta
    • 3
  • Kedar Deodhar
    • 4
  • Venkatesh Rangarajan
    • 5
  • Meenakshi Thakur
    • 6
  • Shyam Kishore Shrivastava
    • 1
  1. 1.Department of Radiation OncologyTata Memorial HospitalParel, MumbaiIndia
  2. 2.Department of Surgical OncologyTata Memorial HospitalParel, MumbaiIndia
  3. 3.Department of Medical OncologyTata Memorial HospitalParel, MumbaiIndia
  4. 4.Department of PathologyTata Memorial HospitalParel, MumbaiIndia
  5. 5.Department of Nuclear MedicineTata Memorial HospitalParel, MumbaiIndia
  6. 6.Department of RadiologyTata Memorial HospitalParel, MumbaiIndia

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