Abstract
PurposeTo review the clinical outcomes of extended-field radiation therapy (EFRT) and to analyze prognostic factors significant for survival in patients receiving EFRT for uterine cervical carcinoma with para-aortic node (PAN) metastasis.Patients and methodsWe retrospectively reviewed 90 patients with stage IB-IVA cervical cancer and PAN metastasis between 1987 and 2012. Median age was 50 (range, 24–77). Patients received median 70.2 Gy (range, 56–93) to point A and median 50.4 Gy (range, 45–60.4) to PAN over median 69 elapsed days (range, 43–182). Forty-six patients (51.1%) received concurrent chemotherapy. Survival was calculated using the Kaplan–Meier method. We analyzed prognostic factors for overall actuarial survival (OS) and progression-free survival (PFS) using a Cox regression method.ResultsThe median follow-up period for surviving patients was 55 months (range, 3–252). Seventy patients (77.8%) had complete remission. Forty-six patients experienced treatment failure as follows: 11 patients (12.2%) as local recurrence, 19 (21%) as regional recurrence and 33 (36.7%) as distant metastasis. The 5-yr OS and PFS were 62.6% and 43.9%, respectively. Treatment response was the only statistically independent prognostic factors for OS (p= 0.04) and PFS (p< 0.001) on multivariate analysis. Grade 3 or 4 hematologic gastrointestinal and urogenital toxicities were observed in about 10% of patients.ConclusionsOur institutional experiences showed that EFRT was an effective treatment for cervical cancer patients with PAN metastasis. The addition of chemotherapy to EFRT seems to have uncertain survival benefit with higher hematologic toxicity.Electronic supplementary materialThe online version of this article (doi:10.1186/s13014-014-0320-5) contains supplementary material, which is available to authorized users.
Highlights
Our institutional experiences showed that extended-field radiation therapy (EFRT) was an effective treatment for cervical cancer patients with Para-aortic node (PAN) metastasis
Para-aortic node (PAN) metastasis is an important prognostic factor, the International Federation of Gynecology and Obstetrics (FIGO) staging system of uterine cervical cancer does not allow for the involvement of nodes [1]
This study showed that EFRT was an efficient treatment for uterine cervical cancer with involved PAN, with a 5year overall actuarial survival (OS) of 62.6% and progression-free survival (PFS) of 43.9%
Summary
Para-aortic node (PAN) metastasis is an important prognostic factor, the International Federation of Gynecology and Obstetrics (FIGO) staging system of uterine cervical cancer does not allow for the involvement of nodes [1]. According to the Gynecologic Oncology Group, biopsy-confirmed PAN involvement was found in 5% of Stage IB patients, 17% of Stage IIB patients, and 25% of. Stage IIIB patients; poor survival rates of these patients were reported [2]. Extended-field radiation therapy (EFRT) is conventionally indicated for cervical cancer patients with grossly detected common iliac or PAN metastasis. In several previous studies on EFRT, a 5-year overall survival rate of 29 – 32% was reported [3,4,5]. Some investigators have tried to reduce the toxicity of EFRT plus concurrent chemotherapy using intensity-modulated radiotherapy or
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