Re-irradiation with image-guided radiotherapy for recurrent cervical cancer: an analysis of outcomes and toxicity.
- 1Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China.
- 2Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China. [email protected].
- 3Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China. [email protected].
Abstract
Objective
Recurrent cervical cancer within previously irradiated fields remains a major therapeutic challenge. This study aimed to evaluate clinical outcomes and safety of image-guided re-irradiation and to identify prognostic factors associated with tumor control and treatment-related toxicity.Methods
All consecutive patients who underwent image-guided re-irradiation between March 2020 and December 2024 were retrospectively analyzed. Re-irradiation was delivered using image-guided external beam radiotherapy and/or image-guided brachytherapy. Concurrent chemotherapy or immunotherapy was administered when clinically indicated. Organ at risk doses were recorded from re-irradiation plans. Logistic models were applied to evaluate tumor control probability and normal tissue complication probability.Results
A total of 102 patients were included. At recurrence, 45.1% had central relapse, 14.7% pelvic relapse, 17.6% combined central and pelvic relapse, and 22.5% had distant metastasis. The median re-irradiation dose was 56.8 Gy (a/β = 10). With a median follow-up of 13.7 months, the 1- and 2-year LC were 67.6% and 59.2%, and the 1- and 2-year PFS were 52.7% and 42.6%. Higher re-irradiation prescription EQD2 was associated with improved tumor control. A progression-free interval > 2 years after initial radiotherapy predicted better progression-free survival and local control, whereas distant metastasis was associated with inferior progression-free survival. Higher rectal and bladder D2cc values were significantly associated with increased late toxicity. The risk of grade ≥ 2 late complications rose substantially when the rectal or bladder D2cc exceeded approximately 50 Gy (a/β = 3). No grade 4 or 5 toxicities were observed in this study.Conclusion
Re-irradiation is a feasible and effective salvage option for patients with recurrent cervical cancer and provides moderate local control with acceptable toxicity.
Related
- Safety and Efficacy of Photon Re-Irradiation with Whole-Brain Radiotherapy or Craniospinal Irradiation for Recurrent Pediatric Central Nervous System Malignancies.
- Intensity-modulated radiotherapy combined with albumin-bound paclitaxel and platinum-based chemotherapy for locoregional recurrent cervical cancer: a single-institutional phase II investigator-initiated nonrandomized clinical trial
- Clinical outcomes and toxicity after proton- versus photon-based spatially fractionated radiotherapy for soft-tissue sarcoma: a retrospective cohort
- Predicting outcomes in locally advanced cervical cancer treated with radiotherapy: a systematic review of nomograms
- Overall treatment time and oncologic outcomes after definitive radiotherapy or chemoradiotherapy for cervical cancer: a systematic review and meta-analysis
BibTeX
@article{qi2026reirradiation,
title = {{Re-irradiation with image-guided radiotherapy for recurrent cervical cancer: an analysis of outcomes and toxicity.}},
author = {Xi Qi and Zhiyong Xiang and Weiping Wang and Kai Liu and Xiaorong Hou and Fuquan Zhang and Ke Hu},
journal = {BMC cancer},
year = {2026},
month = jul,
doi = {10.1186/s12885-026-16594-y},
url = {https://europepmc.org/article/MED/42897506},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Re-irradiation with image-guided radiotherapy for recurrent cervical cancer: an analysis of outcomes and toxicity.
AU - Xi Qi
AU - Zhiyong Xiang
AU - Weiping Wang
AU - Kai Liu
AU - Xiaorong Hou
AU - Fuquan Zhang
AU - Ke Hu
PY - 2026
DA - 2026/07/01
JO - BMC cancer
DO - 10.1186/s12885-026-16594-y
UR - https://europepmc.org/article/MED/42897506
AB - Objective Recurrent cervical cancer within previously irradiated fields remains a major therapeutic challenge. This study aimed to evaluate clinical outcomes and safety of image-guided re-irradiation and to identify prognostic factors associated with tumor control and treatment-related toxicity.Methods All consecutive patients who underwent image-guided re-irradiation between March 2020 and December 2024 were retrospectively analyzed. Re-irradiation was delivered using image-guided external beam radiotherapy and/or image-guided brachytherapy. Concurrent chemotherapy or immunotherapy was administered when clinically indicated. Organ at risk doses were recorded from re-irradiation plans. Logistic models were applied to evaluate tumor control probability and normal tissue complication probability.Results A total of 102 patients were included. At recurrence, 45.1% had central relapse, 14.7% pelvic relapse, 17.6% combined central and pelvic relapse, and 22.5% had distant metastasis. The median re-irradiation dose was 56.8 Gy (a/β = 10). With a median follow-up of 13.7 months, the 1- and 2-year LC were 67.6% and 59.2%, and the 1- and 2-year PFS were 52.7% and 42.6%. Higher re-irradiation prescription EQD2 was associated with improved tumor control. A progression-free interval > 2 years after initial radiotherapy predicted better progression-free survival and local control, whereas distant metastasis was associated with inferior progression-free survival. Higher rectal and bladder D2cc values were significantly associated with increased late toxicity. The risk of grade ≥ 2 late complications rose substantially when the rectal or bladder D2cc exceeded approximately 50 Gy (a/β = 3). No grade 4 or 5 toxicities were observed in this study.Conclusion Re-irradiation is a feasible and effective salvage option for patients with recurrent cervical cancer and provides moderate local control with acceptable toxicity.
SN - 1471-2407
ER -