3552 - Outcomes of Salvage Radiotherapy and Chemotherapy for Vaginal Vault Carcinoma Following Earlier Hysterectomy

S. Pradhan¹, A. Shinghal¹, J. Pattanaik¹, P. Giridhar¹, A. R. Kapoor¹, D. S. Basak¹, L. Pujari², A. Mukherji¹, N. Patil¹, and A. Pal¹; ¹Mahamana Pandit Madan Mohan Malaviya Cancer Centre, Varanasi, India, ²Mahamana Pandit Madan Mohan Malaviya Cancer Centre and Homi Bhabha Cancer Hospital, Homi Bhabha National Institute, Varanasi, India

Purpose/Objective(s): Cervical cancer, a common malignancy amongst women, usually present in advanced stages, especially in Low Middle-Income Countries (LMICs). In LMICs, inadequate hysterectomy is common due to improper evaluation and / or lack of expertise in primary care hospitals, resulting in high vault recurrence rates. A retrospective analysis was carried out on such patients, presenting and treated with chemoradiation (CTRT) at a tertiary care cancer centre. Materials/

Methods:

Study included 83 patients, presenting between June 2020 and August 2023, who had undergone hysterectomy and later had disease at vault £60 months following earlier surgery. After thorough workup, patients underwent definitive radiotherapy(RT), 50Gy/25 fractions with concurrent Cisplatin 40mg/m². Neoadjuvant Chemotherapy (NACT) with 3 weekly Paclitaxel + Carboplatin was administered in patients with adjacent organ infiltration. All patients underwent Vault Brachytherapy(BT), 7Gy weeklyX3 fractions. Outcome analysis included Acute and Late toxicities (using RTOG scale), Locoregional Relapse Free Survival (LRRFS), Relapse Free Survival (RFS) and Overall Survival (OS).

Results:

Median age of patients was 51 years. Median time to presentation was 132 days with 45 patients having recurrence £6 months and 38 patients >6 months after initial surgery, respectively. Thirty-one, 49 and 3 patients underwent Total Abdominal (TAH) or Vaginal Hysterectomy, TAH + Bilateral Salpingo-Oophorectomy(BSO) and Subtotal Hysterectomy, respectively. Disease £4cm and >4cm were seen in 49 (59%) and 34 (41%) patients. Squamous cell carcinoma was seen in 80 (96.4%) and Adenocarcinoma in 3(3.6%) patients. 52(62.7%) patients received CTRT, 4(4.8%) received RT alone, and 27(32.5%) received CTRT following NACT. Complete Response and Progressive Disease were seen in 72(86.7%) and 8(9.6%) patients with Partial Response and Stable Disease in 1(1.2%) patients each. One patient died before first assessment due to cardiac cause. In 8 patients with progression during RT, there were 2 local, 3 locoregional and 3 locoregional+ distant failures. Six more patients failed during follow up. With a median follow up of 24 months, 2 year LRRFS, RFS, and OS were seen in 83.9%, 76.7%, and 83.1% patients, respectively. Acute =Grade-3 Skin, Gastrointestinal (GI), and Genitourinary (GU) toxicities were seen in 3(3.6%), 3(3.6%), and 1(1.2%) patient, respectively. Late =Grade-3 GI toxicities was seen in 1(3.6%) patient and no =Grade-3 late Skin and GU toxicities were seen.

Conclusion:

Total and subtotal hysterectomy for locally advanced cervical cancer is common in many LMICs, including India. Definitive CTRT followed by BT shows promising LRRFS, RFS, and OS with acceptable acute and late toxicities. Hence, CTRT improves the outcomes in these patients. However, inadvertent surgery needs to be avoided in patients with invasive cervical cancer.