Clinical analysis of intensity modulated radiation therapy in cervical cancer patients with para-aortic lymph node metastasis after initial treatment

Abstract

Objective To evaluate the efficacy and toxicities of intensity modulated radiation therapy (IMRT) with or without concurrent chemotherapy in the treatment of cervical cancer patients with para-aortic lymph node (PALN) metastases after initial treatment. Methods From Oct 2008 to Aug 2013, 56 cervical cancer patients with PALN metastases after initial treatment, including radical resection or pelvic radiotherapy/chemoradiotherapy, were selected for analysis. The delivered radiation dose to PALN was 55-60 Gy for GTV and 45-50 Gy for CTV respectively with 25-30 fractions during 5-6 weeks. 36 patients received concurrent paclitaxel (135 mg/m2) and cisplatin (60 mg/m2) chemoradiotherapy (CRT group) and 20 patients received RT alone (RT group). Results The median follow-up time after treatment was 22.7 months (2.7 to 74.4 months). 98.2% (55/56) of patients completed RT. In CRT group, 38.9% underwent concurrent TP regimen 2-3 cycles and the rest completed one cycle. The rates of CR plus PR in CRT and RT groups were 91.7% (33/36) and 85% (17/20), respectively (χ2 =0.516, P>0.05). The 3-year overall survival rate in CRT group and RT group were 57.5% and 32.7% (χ2 =4.059, P 0.05). Grade 3 gastrointestinal toxicity occurred in 1 patient each group (χ2 =0.847, P>0.05). Conclusions TP regimen concurrent CRT is associated with better survival than RT alone, and the treatment toxicities could be tolerant. Key words: Cervical cancer; Para-aortic lymph node metastases; Intensity modulated radiation therapy; TP regimen chemotherapy.