Follow-up strategies for patients with cervical cancer who achieved complete response after definitive...

In patients who have achieved a complete response following definitive concurrent chemoradiotherapy for cervical cancer, there remains limited guidance for follow-up strategies despite a recurrence rate of 10% to 20%. We assessed the value of meticulous cross-sectional imaging for follow-up and identified subgroups that could benefit from intensive surveillance among those achieving complete response.

We reviewed the medical records of cervical cancer patients and assessed primarily with pelvic magnetic resonance imaging (MRI) and/or positron emission tomography (PET)-computed tomography (CT) at 3 months post-concurrent chemoradiotherapy. Follow-ups were conducted every 3 months for 2 years, followed by biannual evaluations. Follow-up protocols included Pap smears, X-rays, tumor markers, CT, MRI, and PET-CT, as determined by the attending physician. We analyzed the sites of failure, detection methods, and prognostic factors.

The median follow-up duration was 61.3 months (range; 6.5-244.6). Among 428 patients with complete response, 86 patients (20.1%) experienced recurrences, predominantly distant metastases (86%). Of all recurrences, 67.4% were asymptomatic, and symptomatic recurrences were significantly associated with poorer overall survival compared to asymptomatic cases (HR 2.23, p = .003), predominantly detected through cross-sectional imaging. Chest CT or PET-CT identified the majority of chest metastases (75.7%). Multivariate analysis revealed significant risk factors for poor overall survival: extended-field radiotherapy, age ≥57; for locoregional recurrence: extended-field radiotherapy, tumor size ≥4 cm, non-squamous cell carcinoma, absence of diagnostic PET-CT; and for distant metastasis: extended-field radiotherapy, 2-dimensional radiotherapy.

Even in patients achieving complete response, rigorous surveillance using abdominal-pelvic CT or MRI is advisable, particularly for those with high-risk factors, as it enables early detection of asymptomatic recurrences, which correlates with improved survival. Additionally, for patients treated with extended-field radiotherapy, incorporating chest CT in the follow-up is also recommended.