Prognostic Importance of the site of Recurrence in Patients with Metastatic Recurrent Cervical Cancer

Abstract Purpose The clinical characteristics and outcomes of patients with metastatic recurrent cervical cancer remain poorly understood. The goals of this study were to investigate survival outcome according to the site of recurrence in a large cohort of cervical cancer patients. Methods and Materials Of 1,322 patients with primary cervical cancer from 2000 to 2013, 205 patients with recurrence after primary or adjuvant post-operative radiation were enrolled retrospectively. Aggressive salvage therapy (AST), which was defined as salvage therapy that aimed not only to relieve symptoms but also to ablate recurrent tumors via the single or combined application of surgical resection of local recurrence, metastasectomy, or metastasis-directed irradiation followed by chemotherapy, was performed according to our institutional guidelines. The patterns of recurrence, application rate and mode of AST, and survival outcome were evaluated retrospectively under approval from the institutional review board. Results Regarding the pattern of recurrence, distant-only (DO) recurrence was most common (59.5%), followed by combined (21.5%), central (cervix or vaginal stump) (10.7%) and pelvic (pelvic lymph nodes or pelvic side wall) (8.3%) recurrence. Two subgroups (distant lymph nodes and lung parenchyma) of the DO group demonstrated remarkably good prognosis and were categorized as Type-A DO, whereas the other subgroups were labeled Type-B DO. Patients with type-A DO recurrence constituted 36% of all recurrences and 83.8% of them received AST. The five-year overall survival rates were significantly higher in the Type-A DO group than in the other groups (44.8% in the Type-A DO group, 12.6% in the pelvic group, and 6.8% in the Type-B DO group). Conclusions We identified a patient subgroup with favorable outcome after salvage therapy, Type-A DO, which was defined as recurrence in distant lymph nodes only or in the lung parenchyma only. A future prospective trial is needed to investigate whether AST improves survival in this group.