Identifying Determinants of Outcome in Post-Radiotherapy Cervical Carcinoma Requiring Adjuvant Surgery

• Dr. Latha Kiran Krishna Rajendran

  Author

Cervical carcinoma that persists definitively after chemoradiotherapy poses a major therapeutic challenge. Candidate selection for salvage surgery is vital to optimize outcomes. A multicenter retrospective cohort study was conducted to evaluate the clinical, surgical, and pathological factors affecting survival in patients undergoing salvage hysterectomy for residual cervical carcinoma following radiotherapy. A total of 99 patients who were treated across 25 institutions were evaluated using Cox proportional hazards regression analysis to find prognostic factors of progression-free survival (PFS). The duration of follow-up was adequate enough to assess prognosis. PFS was predicted independently by time from completion of RT to detection of residual disease, surgical margin status, and anatomic extent of residual disease according to multivariable analysis. Patients whose disease was detected early had negative surgical margins, and whose tumour was confined to the cervix had improved survival. Given these results, the SAL-HYS scoring system was created to risk-stratify patients, with patients labelled as low-risk achieving a 4-year PFS and overall survival of approximately 80%. These results highlight that surveillance on time, accurate pre-operative evaluation, and complete surgical resection enhance outcomes for persistent cervical carcinoma after radiotherapy.

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