Cervix carcinoma, concurrent chemoradiation,ssalvage of isolated para-aortic lymph node recurrences

Abstract

To determine the effect of concurrent chemoradiation therapy on outcome of patients with invasive cervical carcinoma, who suffered disease recurrence isolated to the para-aortic lymph nodes. Between 1987 and 2003, 816 cervical carcinoma patients received radiation therapy. Fourteen patients suffered clinically/radiographically detected isolated para-aortic lymph node metastases. Before 1998, imaging was done if warranted by one or more classic findings including lower extremity edema, sciatic pain, and hydronephrosis. After 1998, radiographic imaging was routinely used in all patients. The median age at recurrence was 42.5 years (range, 32–54.) Follow-up for all patients is current or complete. Full dose radiation therapy equaled at least 45 Gray. All seven patients with a classic finding of recurrence, none treated with full dose concurrent chemoradiation, were dead of disease within 1.5 years. The seven patients without a classic finding of recurrence, all treated with full dose concurrent chemoradiation, had a 5 year overall survival of 100% (p < 0.01.). Salvage concurrent full dose chemoradiation affords excellent survival of patients, without classic findings, who suffer disease recurrence exclusively in the para-aortic lymph nodes. Conversely, chemotherapy or radiation therapy alone produces dismal survival in patients with classic findings of recurrence