Curative Radiotherapy for Stage IVB or Recurrent Uterine Cancer Presenting With Supraclavicular or Mediastinal Lymph Node Metastasis

Abstract

Uterine cancer patients with supraclavicular or mediastinal lymph node metastasis are usually considered candidates for systemic chemotherapy or are treated with palliative radiotherapy for specific symptom control. However, if there are no additional hematogenous metastasis, we hypnotized that curative radiotherapy could be effective. The purpose of this study was to evaluate the efficacy and toxicity of radiotherapy with curative intent to this type of patients.The medical records of uterine cancer patients with supraclavicular or mediastinal lymph nodal metastases, who received radiotherapy for curative intend were reviewed. Both who were initial presented with these lymph node metastases and who were presented as recurrence after treatment were included. Patients with hematogenous metastasis were excluded from the analysis. Overall survival and progression free survival, acute and late adverse effect (NCI-CTC ver. 5) was evaluated. In patients with recurrence, the first site of recurrence was also recorded.Eligible patients were 30 (supraclavicular lymph node metastasis: 23, mediastinal lymph node metastasis: 7). Median age was 52 (range 36-82) years. The primary site was cervical cancer in 24 and endometrial cancer in six. De novo tumors were 20 and recurrent tumors were 10. Out of the cervical cancer patients, one patient presented with adenocarcinoma, and the rest had squamous cell carcinoma. Concomitant systemic therapy was performed in 26 patients, which was platinum based in 20 patients, 5FU in five patients, medroxyprogesterone in one patient. The patients with PS0, 1, 2 were 27, 2, 1, respectively. All patients received 60 Gy in 30 fractions to the metastatic site (if de novo tumors, also brachytherapy, whole pelvis and paraaortic lymph node was included). Median follow-up was 16 (range 3-120) months. Acute grade 3-4 esophagitis, neutropenia, anemia, and thrombocytopenia were observed in 6.7%, 56.7%. 40.0% and 13,3%. Late toxicity was observed in one patient which was grade 1 skin induration. One- and two-year overall survival was 66.1% and 45.4%, respectively. One-and two-year progression free survival was 47.4% and 30.7%, respectively. On multivariate analysis, serum squamous cell carcinoma antigen < 6 ng/mL had correlation with good progression free survival. First site of recurrence was lymph node in 11, lung metastasis in six patients, brain metastasis in three patients, and peritoneal dissemination in two patients (one patients presented with two sites of metastasis).Curative radiotherapy is feasible for Stage IVB or recurrent uterine cancer presenting with supraclavicular or mediastinal lymph node metastasis without hematogenous metastasis. Large scale, prospective trials are warranted.A.I. Saito: None.