Radical hysterectomy for recurrent or persistent cervical cancer following radiation therapy

The objective of this paper was to determine the role of radical hysterectomy in persistent or recurrent cervical cancer after primary radiation therapy. Between 1982 and 1995, 34 patients underwent radical hysterectomy for persistent (n = 15) or recurrent (n = 19) cervical cancer after primary radiotherapy. Univariate analysis using log-rank comparison of survival curves was conducted to identify clinical and pathologic factors predictive of survival. The median tumor size at the time of recurrence or persistence was 3.2 cm (range 1-6 cm). 24 patients (70%) had recurrence limited to the uterine cervix; four (12%) had vaginal involvement and six (18%) had early parametrial involvement. No treatment-related deaths were observed. Eighteen major complications (grade III-IV) occurred in 15 cases (44%); 5 patients experienced a fistula. Mean follow-up time was 81 months (range 33-192 months). Recurrent disease was documented in 20 patients (59%), and median time to recurrence was 37 months (range 4-56 months). Fifteen patients (44%) are alive without evidence of disease at a median survival of 81 months (range 33-192), and 18 patients (53%) died of disease with a median survival of 22 months (range 7-106). One patient died of intercurrent disease. Actuarial 5-year survival rate for the whole group is 49%. Patients with FIGO stage IB-IIA at primary diagnosis, no clinical parametrial involvement, and small (≤ 4 cm) tumor diameter at the time of recurrence show a good prognosis (11/17 alive NED) compared to patients who do not fit the above mentioned criteria (4/17 NED, P = 0.01). We conclude that radical hysterectomy can be offered as an alternative procedure to exenteration only in highly selected patients.