Management of recurrent cervical cancer

Approximately 30% of cervical cancer patients will ultimately fail after definitive treatment. The reported 5-year survival rates of patients with treatment failure are between 3.2% and 13%. Management of recurrences depends on the extent of disease, primary treatment, and performance status/comorbidity. Primary treatment, relapse pattern, and characteristics at presentation are determinants for prognosis after recurrence. Concurrent chemoradiation achieves significantly better outcome than radiation alone in patients with recurrences after primary radical hysterectomy. Isolated paraaortic lymph node metastasis and local recurrence confined to cervix were associated with better outcome in failure after definitive radiotherapy. When definitive radiotherapy or surgery plus adjuvant radiotherapy has failed, pelvic exenteration is usually necessary for those had central relapse with clear pelvic side-wall and free of distant metastasis. Radical hysterectomy with or without pelvic node dissection is considered feasible for small uterine and/or vaginal recurrences with high operative morbidity. For patients who have recurrences involving the irradiated pelvic wall, pelvic exenteration is usually not an option for curative intent. Intraoperative radiotherapy, combined operative radiotherapeutic treatment, and laterally extended endopelvic resection have been used in such situations with some success. Chemotherapy alone is basically palliative. Generally, combination chemotherapy could attain higher response rates with no significant improvement in overall survival than cisplatin alone. Recent investigations indicated benefits of positron emission tomography in more accurate restaging of recurrent disease. The impact of various post-treatment surveillance strategies to early detect treatment failure remains to be evaluated.