ESTRO 2024 - Abstract Book

S1076

Clinical - Gynaecology

ESTRO 2024

Conclusion:

Radiotherapy, the curative treatment for many patients with locally advanced cervical therapy, can result with changes on Pap smear cytology [3;4].

Although detection rate of recurrent cervical cancer using cervical and vaginal cytology alone is relatively low [5], NCCN guidelines 2024 recommend cervical cytology screening annually. Studies that have indicated that asymptomatic patients with stage I or II cervical cancer after treatment did not have recurrences detected through Pap smears [6]. As a result, the NCCN panel does not recommend an extensive evaluation for low-grade squamous dysplasia found during surveillance. Our study showed that 2 out of the 10 local recurrences were detected first by Pap smear. Yet, these 2 recurrences were also associated with symptoms which would have motivated the healthcare providers to do vigorous investigation to exclude recurrence even if Pap smear did not detect it. Also, 18 Pap smears showed abnormalities, ranging from ASCUS to squamous cell carcinoma, which were not associated with local recurrence. A study conducted in 2012 showed that performing routine Pap smears for detecting cervical cancer recurrence was only beneficial for 6.2% of patients [7]. Accordingly, Pap smear may not add substantial benefit in the course of follow up for patents treated with radiotherapy to detect local recurrence, and most abnormalities shown on Pap smear do not correlate with actual pathology or recurrence. Limitations of the study include the low incidence of local recurrence, which makes it harder to appreciate the role of Pap smear to detect it. Also, short follow up can limit the number of local recurrences, although signifies the role of Pap smear in the first 2-3 years after diagnosis.

Keywords: Pap smear, cervical cancer, radiotherapy

References:

[1] H. Sung et al., “Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries,” CA: a Cancer Journal for Clinicians, vol. 71, no. 3, pp. 209–249, Feb. 2021, doi: https://doi.org/10.3322/caac.21660.

[2] A. Wagner, A. Jhingran, and D. Gaffney, “Intensity modulated radiotherapy in gynecologic cancers: Hope, hype or hyperbole?,” Gynecologic Oncology, vol. 130, no. 1, pp. 229–236, Jul. 2013, doi: https://doi.org/10.1016/j.ygyno.2013.04.052.