Evaluation of Various Surgical Options in Post-irradiation Cancer Cervix with Central Residue or Recurrence

The standard treatment for post-irradiation cancer cervix with central residue or recurrence is pelvic exenteration. Some of the carefully selected patients with lesions of size less than 2 cm may be treated with radical hysterectomy. Patients treated by radical hysterectomy have less morbidity rates when compared to pelvic exenteration. The parameters for defining a subset of these patients have not been addressed. Given the changing scenario of organ preservation, we have to determine the role of radical hysterectomy after radical or defaulted radiotherapy treatment. Retrospective analysis of patients with post-irradiation cancer cervix with central residue or recurrence who were treated by surgery from 2012 to 2018 was done. The initial stage of the disease, radiation treatment details, recurrence/residue, extent of disease as per imaging, surgical findings, histopathological examination report, post-surgery local recurrence, distant recurrence and 2-year survival rates were analysed. A total of 45 patients were found eligible for the study from the database. Nine (20%) patients, who had tumours that were confined to cervix, size less than 2 cm with preserved planes of resection, underwent radical hysterectomy and the other 36 (80%) patients underwent pelvic exenteration. Among patients who underwent radical hysterectomy, one (11.1%) patient had parametrial involvement and all of them had tumour-free resection margins. Among patients who underwent pelvic exenteration, 11 (30.6%) patients had parametrial involvement and five (13.9%) patients had tumour infiltrated resection margins. Among patients who were treated by radical hysterectomy, the local recurrence rate was high in patients who had a pretreatment FIGO stage of IIIB when compared to stage IIB (33.3% vs. 20%). Out of the nine patients treated by radical hysterectomy, two patients had local recurrence and both of them did not receive brachytherapy preoperatively. In patients with an early stage carcinoma cervix with post-irradiation residue or recurrence, radical hysterectomy can be considered if the patient consents to participate in a trial, willing to be on strict follow-up and understands the postoperative complications. Large-scale studies for radical hysterectomy have to be done on post radical irradiation small volume early stage residue or recurrence, to identify the parameters for safe and comparable oncological outcomes.