Stereotactic Body Radiotherapy as a Salvage Treatment for Regional Lymph Node Recurrence of Cervical Cancer: Two Case Reports With Complete Metabolic Response and Literature Review.

内容摘要

Locoregional and regional nodal recurrence remains a major therapeutic challenge in cervical cancer, particularly in patients previously treated with pelvic radiotherapy, where salvage options are limited by cumulative toxicity to surrounding organs at risk. In selected patients with limited-volume recurrent disease, stereotactic body radiotherapy (SBRT) has emerged as a highly conformal salvage approach capable of delivering ablative radiation doses while minimizing exposure to adjacent normal tissues. We report two cases of limited-volume regional nodal recurrence from cervical squamous cell carcinoma successfully managed with SBRT. The first patient, a 32-year-old woman initially diagnosed with International Federation of Gynecology and Obstetrics (FIGO) 2018 stage IIIC1 disease, developed multifocal pelvic and para-aortic lymph node recurrence 12 months after completion of definitive treatment. The second patient, a 48-year-old woman with FIGO 2018 stage IIB disease, presented with isolated para-aortic nodal recurrence after a 33-month disease-free interval. In both cases, recurrence was identified by fluorine-18 fluorodeoxyglucose positron emission tomography-computed tomography (18F-FDG PET-CT) and discussed in a multidisciplinary tumor board. Histological confirmation was not obtained because of the deep location of the lesions, their proximity to major vascular structures, the procedural risks of biopsy, and the highly suggestive PET-CT findings in patients with previous cervical squamous cell carcinoma. Salvage surgery was considered technically challenging because of previous irradiation and fibrosis. SBRT was delivered using volumetric modulated arc therapy (VMAT) with daily image guidance. The first patient received 40 Gy in five fractions for pelvic and para-aortic nodal recurrence, whereas the second received 30 Gy in three fractions for isolated para-aortic nodal recurrence. Treatment was well tolerated, with no acute grade ≥2 toxicity and no late grade ≥3 toxicity observed. Follow-up PET-CT demonstrated a complete metabolic response in both patients. At the last follow-up, the first patient remained disease-free 38 months after SBRT, and the second patient remained disease-free 40 months after SBRT, without evidence of progression or significant late toxicity. SBRT appears to be a feasible and well-tolerated salvage option for selected patients with limited-volume regional nodal recurrence of cervical cancer after prior definitive chemoradiotherapy. PET-CT-guided SBRT allows delivery of ablative doses with durable local control while limiting toxicity to previously irradiated normal tissues. These findings support further prospective evaluation of curative-intent local treatment strategies in this setting.