Recurrent cervical cancer |
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Authors: | Leitao Mario M Chi Dennis S |
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Institution: | (1) Gynecology Service,Department of Surgery,c/o Gynecology Service Academic Office, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, Room MRI-1027, 10021 New York, NY, USA |
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Abstract: | Opinion statement There are limited treatment options for patients with recurrent cervical carcinoma. Because of low response rates and a negligible
impact on long-term survival, the use of chemotherapy in patients with unresectable recurrent disease should be considered
palliative. Generally, radiation therapy in previously irradiated patients is considered palliative. For patients who develop
recurrent disease after definitive surgery who have not received prior radiation therapy, salvage radiation therapy is the
treatment of choice. Similarly, patients who have received definitive primary radiation therapy are candidates for surgical
resection of their recurrence. However, there are specific criteria for surgical resection. Radical hysterectomy may be an
option for the very rare patient with a small (<2 cm) centrally located recurrence in the cervix or vaginal fornices. However,
for most patients, pelvic exenteration remains the only therapeutic option that offers the possibility of long-term survival.
Patients who are candidates for exenteration are those with central local recurrences that have not extended to the pelvic
sidewalls. The introduction of high-dose-rate intraoperative radiation therapy (HDR-IORT) combined with radical surgical resection
has widened the scope of patients who may be offered surgery. Patients who in the past may not have been surgical candidates
may benefit from radical surgical resection combined with HDRIORT. All patients who are surgically fit and have undergone
previous radiation therapy should be considered for surgical resection for centrally located recurrences. Patients whose recurrences
extend close to the pelvic sidewalls should be referred to centers where HDR-IORT is available. |
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