Is long-term survival possible when conventional cervical cancer treatment options are exhausted?

When local recurrence happens, treatment options are limited due to the frequent use of pelvic irradiation for primary cervical cancer. Reirradiation is usually contraindicated and chemotherapy is ineffective at controlling tumors located within the previously irradiated tissue, in the case of persistent or recurrent cervical cancer, pelvic exenteration (PE) is on of the few options to offer patients a radical treatment. This is the first analysis from Estonia evaluating prognostic factors associated with locally advanced cervical cancer and the potential for long-term survival with pelvic exenteration. Between 2001 and 2021, PE was performed in 25 patients with recurrent or persistent pelvic cancer after radical radiochemotherapy. Included were 22 cervical cancer and 3 vaginal cancer cases who were followed until 01 June 2022. Clinicopathological characteristics of patients were described in univariate analysis and prognostic factors were estimated with Cox proportional hazard analysis. The median age was 58 years (range 34–80). Median tumor diameter was 6 cm (range 2–14 cm). Total PE, anterior PE and PE with rectal anastomosis consisted of 44%, 36% and 20% of cases respectively. Additional vulvectomy was performed 28% of patients. The median follow-up was 92 months. The overall postoperative complication rate was 32%; the postoperative mortality rate was 0%. Median hospitalization was 16 days (range 9–34). Overall survival was as follows: 1 year 64%, 3 year 40%, 5 year 32% and 15 year 24%. In this case series, we find that even in patients with recurrent or persistent locally advanced cervical cancer, at least a quarter of patients treated with pelvic exenteration can achieve a survival of more than 15 years. PE can be performed with a low postoperative complication rate and zero mortality. PE allows significantly longer survival for patients who have exhausted other treatment modalities.

Cervical cancer; Pelvic exenteration; Complications; Long-term survival

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