Disease courses in patients with residual tumor following concurrent chemoradiotherapy for locally advanced cervical cancer

- 60% of patients with residual tumor did not show further progression without salvage treatment.
- The type of salvage treatment did not affect survival.
- Initial and residual tumor sizes were significant prognostic factors for survival.

ObjectiveTo investigate the disease course and identify prognostic factors for survival in patients with residual disease according to post-treatment magnetic resonance imaging (MRI) following definitive concurrent chemoradiotherapy (CCRT) for locally advanced cervical cancer.MethodsWe reviewed clinical data from the medical records of 545 consecutive women with biopsy-proven, International Federation of Gynecology and Obstetrics stage IB2-IVA uterine cervical cancer treated with CCRT. Post-treatment MRI was checked in all patients 3 months after CCRT completion. Out of the 545 patients, 53 with residual cervical cancer based on MRI following definitive CCRT were included in this analysis.ResultsThirty-two patients were disease-free at the last follow-up. Of them, 31 had a residual tumor size of ≤ 2 cm. Of these 32 women, 30 showed spontaneous regression of residual tumor during follow-up without salvage treatments, whereas the remaining two were alive with no evidence of disease after salvage surgery and chemotherapy. Disease progression was observed in 21 patients, including 7 local, 8 distant and 6 local and distant failures. Of these 21 women, 13 died of disease, 6 were alive with disease, and 2 remained disease-free after salvage treatments. Initial and residual tumor sizes were significant prognostic factors for overall survival; only residual tumor size was significant for local progression-free survival.ConclusionsAbout 60% of patients with residual disease detected on post-treatment MRI remained disease-free without further disease progression. Careful observation without immediate salvage treatments might be feasible in selected patients with a residual tumor size ≤ 2 cm.