Impact of radiation therapy on survival for para-aortic lymph node only recurrence in patients with uterine cervical squamous cell carcinoma

Abstract

5145 Background: Most patients who had any recurrent sites of cancer, have been considered to be last-stage of life. However, recent advances of clinical research reveal some patients achieve long-term survival even in recurrence cases. Furthermore, patients who had only one recurrent region, even radiation therapy could play an important role. As for uterine cervical squamous cell carcinoma, the most common recurrent site other than pelvis is para-aortic lymph node because of spreading more frequently through lymphatic route than hematogeneous one. Furthermore, improvement of diagnostic imaging enables us to detect more frequently only para-aortic lymph node recurrence. Thus, we conducted the current retrospective study. Methods: Between 1994 and 2003, about 2500 uterine cervical squamous cell carcinoma patients treated with curative intended treatments at Kitasato Univ Hsp or the Cancer Inst Hsp Japan Fdn for Cancer Rsch, Japan. Out of them, 28 patients developed para-arotic lymph node recurrence as the only site of initial tumor progression. These patients were treated with external beam radiation therapy. Radiation therapy protocol was as follows. 1.7–2.0 Gy per fraction, 5 fractions per week and median total dose was 50 Gy (40–56). Nine patients recieved adjuvant chemotherapy (6:BOMP, 2:UFT, 1: FP+TJ). Median serum SCC level was 3.6 ng/ml (1.3 - 92.8) at the detection of para-aortic recurrence. Results: Median follow-up time of all patients was 15 months (2- 62). Three-year overall survival rates of all patients was 26.4%. Stratified by adjuvant chemotherapy, 3-year overall survival rate of adjuvant chemotherapy group was 25.7% and those of radiation alone group was 27.4%, These were almost the same. However, stratified by serum SCC level (cut off level: 15 ng/ml), 3-year overall survival rate of high level group was 0% and those of low level group was 37.5%. Conclusions: The current study suggested that radiation therapy for para-aortic lymph node only recurrence in uterine cervical squamous cell carcinoma could have significant impact on overall survival. Furthermore, low level of serum SCC group could achieve better prognosis of 37.5% of 3-year overall survival. No significant financial relationships to disclose.