Patterns of Treatment Failure after Concurrent Chemoradiotherapy or Adjuvant Radiotherapy in Patients with Locally Advanced Cervical Cancer

Abstract

<b><i>Objective:</i></b> To identify patterns of therapy failure after radiotherapy in Chinese patients with locally advanced cervical cancer (LACC). <b><i>Methods:</i></b> A retrospective study was conducted at a Chinese hospital from June 2012 to July 2018. All analyses were done using SPSS 26. <b><i>Results:</i></b> 105 patients with treatment failure were included. After a median follow-up of 27 months (range 10–82), the 3-year survival rate after therapy failure was 19.4%. In multivariate analysis, squamous cell carcinoma antigen (SCC-Ag) &#x3c;4 ng/mL (<i>p</i> &#x3c; 0.001) and disease-free interval &#x3e;12 months (<i>p</i> = 0.013) showed significant survival benefits. We identified 3 types of failure: distant lymph node metastasis (<i>n</i> = 50), hematogenous metastasis (<i>n</i> = 53) and pelvic failure (<i>n</i> = 48). Most metastatic para-aortic lymph nodes (PALN) were inferior to the level of left renal hilum (84.8%, <i>n</i> = 28). A total of 80% of patients with supraclavicular lymph nodes (SCLN) metastasis ignored imaging on supraclavicular region. For solitary SCLN or lung metastasis, the prognosis was better than that combined with other sites failure, respectively (<i>p</i> = 0.005; <i>p</i> = 0.001). Many patients with central sites recurrence received insufficient doses of intracavitary brachytherapy (IBT) for low tolerance to pain. <b><i>Conclusion:</i></b> The distribution of metastatic PALN is asymmetrical and optimizing clinical target volume to minimize toxicity of para-aortic radiation is necessary. The effect of ultrasonography as preliminary screening and follow-up means on SCLN metastasis can be expected. Pain management and psychological interventions are essential for patients receiving IBT.