ESTRO 2024 - Abstract Book

S1066

Clinical - Gynaecology

ESTRO 2024

Purpose: The treatment of cervical cancer includes, according to its different clinical stages, surgery, radiotherapy and concomitant chemotherapy, with a reported recurrence rate between 25 - 61% after primary treatment.

The recurrence of cervical cancer in the irradiated treatment field after radical or adjuvant management with radiotherapy is 20 – 40%. The only possible curative possibility is pelvic exenteration, with few candidates susceptible to this rescue management. Although intraoperative radiotherapy or SBRT are options for managing local and locoregional recurrences in guidelines, not all treatment centers have these technical modalities. Objective: To evaluate the oncological outcomes in patients undergoing re-irradiation, due to recurrence of cervical cancer, in a previously irradiated field, as well as the toxicity rates and technical varieties of management with radiotherapy in this group.

Material/Methods:

Methods : Retrospective, descriptive study, which included patients diagnosed with cervical cancer, diagnosed and treated with radiotherapy as management of a recurrence, in a period between 2010 and 2020.

A review of the electronic records of patients over 18 years of age, with a proven histopathological diagnosis of cervical cancer in its various histologies and clinical stages reported according to the FIGO 2018 classification, was carried out. Each of the clinical variables of interest were collected. and treatment, and an analysis was carried out by their frequencies, expressing them in percentages.

Results:

Results : 66 patients with cervical cancer treated with ERT were found, for the management of recurrence in a previously irradiated field, of which 32 patients were eliminated due to lack of information in the electronic file, leaving 34 cases for the final analysis. With a median age at recurrence of 64 years, histologies were as described: 11 cases with adenocarcinoma histology (32.4%) and 23 patients with squamous cell carcinoma (67.6%). According to their degree of differentiation we observed 6 (17.6%) well differentiated, 22 (64.7%) moderately differentiated, 6 (17.6%) poorly differentiated.

Clinical stage by FIGO 2018, at diagnosis it was mostly IIB, reporting as described below: IA1: 1 patient (2.9%), IA2: 2(5.9%), IB1: 8(23.8%), IB2: 4 (11.8%), IIB: 13(38.2%), IIIB: 3(8.8%), IVB: 3(8.8%)

Regarding the treatment of the primary one: 20 patients (58.8%) underwent hysterectomy. 31 patients (91.2%) were treated with ERT and brachytherapy and only 3 patients (8.8%) were treated only with brachytherapy, within the initial management. The median total dose of initial treatment with ERT was 50 Gy in 25 fx, and of high-rate brachytherapy was 24 Gy in 4 applications of 6 Gy.

The time elapsed between the diagnosis of the primary and the recurrence was 40.5 months. In the case of 30 patients, it was a recurrence, while 4 patients were taken to re-irradiation in the context of persistent disease.

According to the site of recurrence: 19 patients (55.9%) to vaginal vault, 1(2.9% to vulva, 3 patients (8.8%) to cervix, 7(20.6%) to vagina, 1(2.9%) urinary meatus , 2(5.9%) to groin, 1(2.9%) vaginal introitus.

The RET techniques used for the management of disease recurrences/persistences were: 10 patients (29.4%) with ERT, 18 patients (52.9%) with brachytherapy, 3 patients (8.8%) with electrons and 3 patients (8.8%) with external RT and brachytherapy.