Re-irradiation with image-guided radiotherapy for recurrent cervical cancer: an analysis of outcomes and toxicity.

Authors

Xi Qi, Zhiyong Xiang, Weiping Wang, Kai Liu, Xiaorong Hou, Fuquan Zhang, Ke Hu

Published in

BMC cancer. Volume 26. Issue 1. Jul 24, 2026. Epub Jul 24, 2026.

Abstract

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.
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.
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.
Re-irradiation is a feasible and effective salvage option for patients with recurrent cervical cancer and provides moderate local control with acceptable toxicity.

PMID:
42897506
Bibliographic data and abstract were imported from PubMed on 20 Oct 2026.

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