Symptomatology, localization and treatment of recurrent cervical carcinoma.
In a group of 367 women treated for invasive carcinoma of the cervix tumor recurrence was discovered at an asymptomatic stage in 16 (23%) patients. The tumor recurrence was localized to the pelvis in 29 (41%) cases, in the vaginal wall in 3 (4%) cases, and 39 (55%) patients had distant metastases (with or without recurrent tumor in the pelvis). Curative treatment (surgery, n = 2; radiotherapy, n = 8) was applied in 5/29 (17%) patients whose recurrent disease was confined to the pelvis, in all 3 patients with vaginal recurrence and in 2/39 (5%) of the patients with distant metastases. Permanent remission (follow-up > 36 months) was observed in 2 patients with vaginal recurrence and in one with central recurrence. Temporary complete remission (mean 22 months, range 12-30 months) was observed in 3 patients (2 with central recurrence and one with vaginal recurrence). In 20 (69%) of the patients with central or locoregional recurrence, the primary treatment had been so radical (including adjuvant postoperative or full radiotherapy) that surgical treatment or radiotherapy of the recurrence was not considered possible or worthwhile; moreover, 4 of the patients were older than 80 years of age. In retrospect, exenterative treatment could have been considered in 14 patients (< 70 years) and based on 50% operability, could have led to a cure in 2 to 4 patients with tumor recurrence in the pelvis without distant metastases. Chemotherapy was applied to 10 patients, one of whom went into complete remission of lung metastases (follow-up 108 months).