Treatment options in recurrent cervical cancer (Review)

摘要: The management of recurrent cervical cancer depends mainly on previous treatment and the site extent recurrence. Concurrent cisplatin-based chemo-radiation is choice for patients with pelvic failure after radical hysterectomy alone. However, safe delivery high doses radiotherapy much more difficult in this clinical setting compared primary radiotherapy. Pelvic exenteration usually represents only therapeutic approach curative intent women central relapse who have previously received irradiation. In a recent series, 5-year overall survival operative mortality ranged from 21 to 61% 1 10%, respectively. Free surgical margins, negative lymph nodes, small tumour size long disease-free interval were associated favourable prognosis. Currently, reconstructive procedures (continent urinary conduit, low colorectal anastomosis, vaginal reconstruction myocutaneous flaps) are strongly recommended exenteration. isolated para-aortic node failure, satisfactory chances cure asymptomatic patients. Chemotherapy administered palliative distant or loco-regional recurrences not amenable by surgery Cisplatin most widely used drug, response rate 17-38% median 6.1-7.1 months. Cisplatin-based combination chemotherapy achieves higher rates (22-68%) when single-agent cisplatin, but less than one year. Gynecologic Oncology Group (GOG) trial topotecan + cisplatin obtained significantly longer metastatic persistent cancer. A subsequent GOG study showed trend terms better quality life doublet paclitaxel vs. doublets topotecan, vinorelbine, gemcitabine. Molecularly targeted therapy may represent novel tool, its use alone still investigational.