Management of recurrent cervical cancer. Review of the literature and case report

Abstract

The purpose of this study is to report the use of a gemcitabine- vinorelbine-cisplatin (GVP) regimen as a successful treatment for a patient with recurrent squamous cervical cancer. The patient was initially diagnosed with a Stage IIb squamous carcinoma of the uterine cervix. A radical hysterectomy with pelvic lymphadenectomy was performed. Adjuvant radiotherapy was given. Eighteen years later, a pelvic recurrence with involvement of the pelvic sidewall was diagnosed and treated with the combination of GVP. A complete clinical and radiological response was achieved and a complete pathological response was confirmed afterwards. Currently, 67 months later, the patient is well and there are no signs of disease. We reviewed the literature concerning the staging and the chemotherapeutical and surgical treatment of recurrent cervical. Based on the recent literature, we conclude that pelvic examination, MRI, PET/CT and laparoscopy are essential in staging recurrent disease, and that laterally extended endopelvic resection (LEER) as well as pre-exenterative chemotherapy are promising novel therapeutic modalities for recurrent cervical cancer with pelvic extension in an irradiated area. In order to make recent data more transparant and practical we designed a classification and flow-chart for the management of recurrent cervical cancer.