Patterns of recurrence following hysterectomy and radiation for cervical carcinoma: relationship to residual disease and brachytherapy techniques

Conventional postoperative irradiation following hysterectomy for cervical carcinoma has consisted of external pelvic with or without intra-cavitary vaginal irradiation. In the presence of macroscopically positive margins after initial hysterectomy or in the subsequent context of a central recurrence, such techniques may not be optimum as manifested by the significant rate of local recurrence following conventional irradiation in these settings. The purpose of the retrospective review was to: (a) evaluate pelvic recurrence patterns following initial hysterectomy and radiation in relationship to margin status and brachytherapy techniques in 24 group 1 patients; and (b) evaluate pelvic recurrence patterns in 10 group 2 patients with recurrent disease in relationship to the bulk of residuum after salvage external beam and the brachytherapy techniques used to address this disease. The use of interstitial implantation in select patients with macroscopically positive margins after hysterectomy or persistent central pelvic disease after salvage external beam irradiation is proposed.