Para-aortic Recurrence Research Articles

Secondary debulking surgery for para-aortic nodal recurrence in endometrial cancer requiring circumferential resection of the inferior vena cava

Secondary debulking surgery for para-aortic nodal recurrence in endometrial cancer requiring circumferential resection of the inferior vena cava

Isolated Para-Aortic Nodal Recurrence in Endometrial Cancer

Aim: While cytoreductive surgery should be considered for patients with regional recurrence of endometrial cancer, the management of isolated para-aortic lymph node recurrence remains controversial. We investigated the frequency of isolated recurrence in the para-aortic lymph nodes and the effectiveness of surgery for such recurrence. Methods: A retrospectively maintained endometrial cancer database at the Cancer Institute Hospital in Japan was reviewed to identify sites of metastasis and recurrence. Results: A total of 2322 patients with endometrial cancer underwent primary treatment with systemic lymphadenectomy between 1984 and 2015. Systematic pelvic and para-aortic lymph node dissection was performed in 889 patients (Group 1), while 1433 patients underwent dissection of only the pelvic lymph nodes (Group 2). Although 16 patients (1.1%) in Group 2 had isolated para-aortic recurrences, only 3 patients (0.3%) in Group 1 had documented recurrences in the para-aortic lymph nodes (p = 0.043). Although second recurrence occurred in 30.0% of patients who underwent surgical recurrence treatment, second recurrence occurred in 77.8% of patients who underwent non-surgical recurrence treatment (p = 0.037). In addition, the overall survival rate for patients who underwent surgical recurrence treatment (80.0%) was significantly higher than that for patients who underwent non-surgical recurrence treatment (33.3%) (p = 0.026). Conclusions: Patients who underwent dissection of only the pelvic lymph nodes had a higher frequency of isolated recurrence in the para-aortic lymph nodes. In addition, a relatively good prognosis could be achieved with surgical treatment for isolated recurrence in the para-aortic lymph nodes, which was better than that achieved using non-surgical methods.

Impact of para-aortic recurrence risk-guided intensity-modulated radiotherapy in locally advanced cervical cancer with positive pelvic lymph nodes

ObjectivesA previous study has suggested the benefit of sub-renal vein radiotherapy (SRVRT) for pelvic lymph node (PLN)-positive cervical cancer. In order to better select patients for SRVRT, this study aimed to evaluate the value of a risk-based radiation field based on PLN location and number in PLN-positive cervical cancer. MethodsWe reviewed 198 patients with FIGO stage IB2–IVA cervical cancer, positive PLNs, and negative para-aortic lymph nodes (PALNs) from 2004 to 2015 at two tertiary centers. All patients underwent pelvic radiotherapy (PRT) or SRVRT with IMRT. The SRVRT extended the PRT field cranially to the level of the left renal vein. The prescribed doses were 45–50.4Gy in 1.8Gy per fraction. ResultsOverall, 118 and 80 patients underwent PRT and SRVRT, respectively. The SRVRT group had more advanced disease based on FIGO stage, common iliac PLNs, and number of PLNs. The median follow-up was 63months (range: 7–151months). PALN failure was experienced by 28 patients (23.7%) in the PRT group and 1 patient (1.3%) in the SRVRT group (p<0.001). Compared with PRT, SRVRT significantly improved 5-year PALN recurrence-free survival (56.8% vs. 100%, p<0.001) and cancer-specific survival (56.5% vs. 93.9%, p<0.001) among patients with common iliac PLNs or ≥3 PLNs. No significant differences were observed in these outcomes among patients with PLNs below the common iliac bifurcation and 1–2 PLNs. The SRVRT did not increase severe toxicities. ConclusionsRisk-based radiation field based on PLN location and number could optimize outcomes for PLN-positive cervical cancer.

EO5 - 11C-choline PET-guided salvage intensity modulated radiotherapy with simultaneous integrated boost for isolated pelvic and para-aortic prostate cancer nodal recurrences: Minimal adverse effects

EO5 - 11C-choline PET-guided salvage intensity modulated radiotherapy with simultaneous integrated boost for isolated pelvic and para-aortic prostate cancer nodal recurrences: Minimal adverse effects

Outcomes and patterns of relapse after definitive radiation therapy for oligometastatic cervical cancer

PurposeSurvival rates for women with metastatic cervical cancer are low, with limited management options. Definitive radiation therapy (RT) for oligometastatic disease has led to prolonged survival in other malignancies, but this approach has yet to be systematically studied for cervical cancer. Methods and materialsWe evaluated 38 patients who received definitive RT to oligometastatic sites of cervical cancer at a single institution from 2002 to 2015. Patients presented with synchronous (n=9) or metachronous (n=15) oligometastatic disease to supraclavicular (SCV) nodes, or with recurrent disease in mediastinum (n=10) or lung (n=7). Three patients were treated for both SCV and mediastinal sites, and six patients were treated for para-aortic or pelvic recurrences along with oligometastatic sites. Most received chemotherapy: induction (n=5), concurrent (n=24), or adjuvant (n=5). Outcomes were evaluated via Kaplan-Meier, and associations were examined via Cox proportional hazards modeling. ResultsMedian follow-up was 35.2months (range 3.1–94.7). Median overall survival (OS) was 50.7months from end of RT, with 2-year and 3-year OS rates of 74% and 65%. Median progression-free survival (PFS) was 21.7months, with 1-year and 2-year PFS rates of 63% and 48%. Of the 38 patients, 21 (55%) experienced progression, at a median time of 24.8months. There was one in-field failure. Other relapses occurred regionally (n=10) and distally (n=12), with two patients experiencing both. The most common site of recurrence following treatment of SCV disease was mediastinum (n=7). The incidence of grade≥3 toxicity from treatment of oligometastatic sites was <3%. ConclusionsDefinitive RT to sites of oligometastatic cervical cancer can result in excellent local control, favorable outcomes, and even achieve long-term survival for carefully selected patients, with minimal RT-associated toxicity.

IMRT With Image-Guided Brachytherapy in Non-metastatic Locally Advanced Cervical Cancer

Intensity modulated radiotherapy (IMRT) and image-guided adaptive brachytherapy (IGABT) have been only recently introduced in the treatment of locally advanced cervical cancer (LACC). We retrospectively assessed the overall clinical outcomes, patterns of failure, and toxicity in LACC patients from a single institution in a modern treatment era. A cohort of 138 patients with cervical squamous cell carcinoma or adenocarcinoma was treated with IMRT to a dose of 45 Gy and a boost of 5.4 to 14.4 Gy for involved lymph nodes, with concomitant chemotherapy, and IGABT. D2cc of the rectum, bladder and bowel were converted into the equivalent dose in 2 Gy fractions (EQD2) using a linear quadratic model (α/β=3 Gy). PET-scan was done for all patients at diagnosis and in the majority of patients (N=127) to assess treatment response. We reported late toxicity using RTOG/EORTC scoring system. Kaplan-Meier analyses for overall survival (OS), disease-free survival (DFS), pelvic control (PC) and local control (LC) were performed. Of 138 patients identified and treated between March 2011 and November 2015, 50 had stage IB, 62 had stage II, 21 had stage III and 5 had stage IVA. The median age was 51 years (range, 28-93). Histology was squamous cell carcinoma in 118 patients (85.5%). All patients had a staging PET-scan and 97% had an MRI at diagnosis. MRI tumor volume was >30 cm3 in 47% of cases. Nodal involvement was reported in 82 patients (59.4%). The median follow-up was 28 months. Endocavitary high-dose rate (HDR) IGABT was used for all patients. The median prescribed dose to the tumor was 84.3 Gy. The median D2cc to the bladder, rectum and bowel was 82.2 Gy, 67.6 Gy and 78.9 Gy, respectively. Complete PET response was observed in 113 out of 127 patients (89%). Three-year OS and DFS were 85.3% and 78.9%, respectively. Local control and pelvic control rates at 3 years were 94.8% and 91.9%, respectively. Twenty-seven patients (19.6%) were diagnosed with recurrent disease. Of these, 20 had evidence of distant recurrence and 3 had isolated local relapse. Four patients had only regional nodal recurrence, 3 of which were para-aortic recurrences that were not included in the original treatment field. Median time to relapse was 8 months (range, 2.5-45). Grade ≥ 3 late toxicities for bladder, vagina and bowel were observed in 4%, 3% and 2% of patients, respectively. Contemporary treatment of LACC with chemoradiation using IMRT and IGABT yields to higher rates of OS and DFS compared to previously published series. These good outcomes can be attributed to thorough clinical staging using PET-scan and MRI, the use of IMRT as well as the use of IGABT which allow dose escalation to involved lymph nodes and to the primary tumor without major impact on toxicity. As the majority of recurrences are distant, future trials should focus on optimizing systemic therapy.

11 C-Choline PET-Guided Salvage Radiation Therapy for Isolated Pelvic and Para-aortic Nodal Recurrence of Prostate Cancer After Radical Prostatectomy: Low Rates of Adverse Effects

11 C-Choline PET-Guided Salvage Radiation Therapy for Isolated Pelvic and Para-aortic Nodal Recurrence of Prostate Cancer After Radical Prostatectomy: Low Rates of Adverse Effects

Magnetic resonance imaging during definitive chemoradiotherapy can predict tumor recurrence and patient survival in locally advanced cervical cancer: A multi-institutional retrospective analysis of KROG 16-01.

Definitive chemoradiotherapy (CRT) followed by brachytherapy is a standard treatment for locally advanced cervical cancer. During CRT, marked reduction of cervical tumor is often observed in magnetic resonance imaging (MRI). The primary aim of this study was to assess the association between tumor response in MRI using FIGO classification and clinical outcomes. Multi-institutional data were retrospectively reviewed to identify the significance of MR tumor response on tumor recurrence and patient survival. 225 patients with histologically confirmed squamous cell carcinoma of the cervix, staged as FIGO Ib2-IVa on initial pelvic MRI, were included. Post-CRT MRI was performed median 35days after the beginning of CRT and before brachytherapy. A median 54Gy of external radiation was given with weekly cisplatin during CRT. 112 (49.7%) of the 225 patients showed a positive response in post-CRT MRI and were named the responsive arm. After a median follow-up time of 36.2months, the responsive arm had significantly lower para-aortic recurrence (7.5% vs. 12.4%; p=0.04) and distant metastasis (13.2% vs. 27.6%; p=0.03) rates than did the non-responsive arm. The responsive arm had significantly higher 3-year cause-specific survival rate (94.6% vs. 81.1%, p<0.01) than did the non-responsive arm. In the multivariate analysis, tumor size (hazard ratio, 1.91 and 95% confidence interval, 1.07-3.43; p=0.028) and positive MR response (hazard ratio, 1.75 and 95% confidence interval, 1.06-2.27; p=0.045) were significant factors for recurrence-free survival CONCLUSION: Early tumor response evaluation with MRI using FIGO classification effectively predicted distant tumor metastasis and disease-specific survival in locally advanced cervical cancer.

A randomized phase III trial of cisplatin and tumor volume directed irradiation followed by carboplatin and paclitaxel vs. carboplatin and paclitaxel for optimally debulked, advanced endometrial carcinoma.

5505 Background: Patients with stage III/IVA uterine cancer (UC) carry high risk of systemic and local recurrence. Chemotherapy was shown to reduce systemic recurrence, however the risk of local failure remains high. Methods: The primary endpoint of this open label, randomized phase III trial was to determine if treatment with cisplatin and volume-directed radiation followed by carboplatin and paclitaxel for 4 cycles (C-RT, experimental arm) reduces the rate of recurrence or death (i.e., increases recurrence-free survival, RFS) when compared to carboplatin and paclitaxel for 6 cycles (CT, control arm) in patients with stages III-IVA (&lt;2 cm residual disease) or FIGO 2009 stage I/II serous or clear cell UC and positive cytology. Secondary objectives were assessment of overall survival (OS), acute and late toxicities, and quality of life. A 28.5% reduction in the rate of recurrence or death was considered significant. Treatment randomization and analysis were stratified by gross residual tumor and age. Results: Between 6/2009 and 7/2014, 813 patients were enrolled and randomized (407 C-RT and 406-CT). Of those, 733 were eligible (344 C-RT and 360 CT), and 680 received the trial intervention (333 C-RT and 347 CT). Median follow up is 47 months. Patients characteristics were balanced between arms. There were 201 (58%) &gt; grd 3 toxicity events in the C-RT arm and 227 (63%) in the CT arm. The most common &gt; grd 3 events were myelosupression (40% vs. 52%), gastrointestinal (13% vs. 4%), metabolic (15% vs. 19%), neurological (7% vs. 6%), infectious (4% vs. 5%). Treatment hazard ratio for RFS was 0.9 (C-RT vs. CT; CI 0.74 to 1.10). C-RT reduced the incidence of vaginal (3% vs. 7%, HR = 0.36, CI 0.16 to 0.82), pelvic and paraaortic recurrences (10% vs. 21%, HR=0.43, CI 02.8 to 0.66) compared to CT, but distant recurrences were more common with C-RT vs. CT (28% vs. 21%, HR 1.36, CI 1 to 1.86). The analysis is premature for OS comparison. Conclusions: Although C-RT reduced the rate of local recurrence compared to CT; the combined modality regimen did not increase RFS in optimally debulked, stage III/IVA UC. Clinical trial information: NCT00942357.

Prophylactic lower para-aortic irradiation using intensity-modulated radiotherapy mitigates the risk of para-aortic recurrence in locally advanced cervical cancer: A 10-year institutional experience

ObjectiveTo evaluate the effects of prophylactic sub-renal vein radiotherapy (SRVRT) using intensity-modulated radiotherapy (IMRT) for cervical cancer. MethodsA total of 206 patients with FIGO stage IB2–IVA cervical cancer and negative para-aortic lymph nodes (PALNs) who underwent pelvic IMRT (PRT) or SRVRT between 2004 and 2013 at our institution were reviewed. SRVRT cranially extended the PRT field for PALNs up to the left renal vein level. The prescribed dose was consistent 50.4Gy in 28 fractions. ResultsOverall, 110 and 96 patients underwent PRT and SRVRT, respectively. The SRVRT group had more advanced disease based on FIGO stage and positive pelvic lymph nodes (PLNs). The median follow-up time was 60months (range, 7–143). For the total study population, the 5-year PALN recurrence-free survival (PARFS) and overall survival (OS) for PRT vs. SRVRT were 87.6% vs. 97.9% (p=0.03) and 74.5% vs. 87.8% (p=0.04), respectively. In patients with FIGO III–IVA or positive PLNs, the 5-year PARFS and OS for PRT vs. SRVRT were 80.1% vs. 96.4% (p=0.02) and 58.1% vs. 83.5% (p=0.012), respectively. However, there were no significant differences in these outcomes for patients with FIGO IB–IIB and negative PLNs. In a multivariate analysis, only SRVRT was associated with better PARFS (HR, 0.21; 95% CI, 0.06–0.78; p=0.02). The SRVRT did not significantly increase severe late toxicities. ConclusionProphylactic SRVRT using IMRT reduced PALN recurrence with tolerable toxicities, supporting the application of risk-based radiation fields for cervical cancer.

Survival and Control Prognosticators of Recurrent Gynecological Malignancies of the Pelvis and Para-aortic Region Treated with Stereotactic Body Radiation Therapy.

To define prognostic factors associated with improved survival and local control (LC) for gynecologic cancer recurrences limited to the pelvis and para-aortic (PA) region using stereotactic body radiation therapy (SBRT). Between 2/2008 and 7/2014, 30 women (35 targets) with pelvic or PA recurrence of endometrioid (n = 12), cervical (n = 11), ovarian (n = 3), uterine-serous (n = 2), or carcinosarcoma (n = 2) cancer were treated with SBRT. Eleven recurrences were located in the central pelvis, 11 along the pelvic sidewall (PSW), and 13 in the PA region. Five-year survival for all patients was 42% with a median survival of 43.4 months. Multivariate analysis revealed better performance status (PS), and smaller clinical tumor volume was significant for improved survival (p < 0.05). SBRT is a local therapy for recurrent gynecological malignancies in the pelvis and PA region with curative potential. SBRT is especially effective for LC when targeting PSW or PA recurrence and for patients with a cervical/endometrioid uterine primary. Survival is improved for patients with better PS and smaller recurrence volume prior to SBRT.

Impact of paraaortic lymphadenectomy for endometrial cancer with positive pelvic lymph nodes: A Korean Radiation Oncology Group study (KROG 13-17)

AimWe investigated the role of paraaortic lymph node dissection (PALND) in patients with stage IIIC1 endometrial carcinoma after surgery followed by adjuvant radiotherapy (RT) alone or chemoradiotherapy (CTRT). MethodsWe performed a subgroup analysis in 151 patients treated with adjuvant pelvic RT. Paraaortic-recurrence free survival, disease-free survival (DFS) and overall survival (OS) were analyzed. ResultsIn adjuvant RT alone, PALND was significantly related to reduced risk of paraaortic recurrence (0% vs. 17.1%) and distant metastasis (4.5% vs. 19.5%) compared with the no PALND group. PALND affected 5-year DFS (90.2% vs. 58.9%, p = 0.016) and OS (100% vs. 83.1%, p = 0.022). For the CTRT group, the paraaortic recurrence rate was 19.5% for the no PALND group and 12.8% for the PALND group (p = 0.682). Of patients who underwent PALND in the CTRT group, less extensive PALND was significantly related to increased paraaortic recurrence (≤10 vs. >10 dissected LNs, 17.1% vs. 0%). In the no PALND group (n = 82), 5-year paraaortic-recurrence free survival was 79.4% for the CTRT group and 76.2% for the RT alone group (p = 0.941). In multivariate analysis, PALND was significantly associated with reduced risk of disease-specific death (HR, 0.50; 95% CI, 0.26–0.96; p = 0.037). ConclusionPALND provided excellent paraaortic control and improved outcome in stage IIIC1 endometrial cancer with favorable tumor features treated with adjuvant RT alone. Less extensive PALND was associated with significantly increased paraaortic recurrence in patients with advanced tumor features treated with adjuvant CTRT. Combined CTRT did not affect disease control in the paraaortic region compared with RT alone.

Secondary debulking surgery for isolated para-aortic nodal recurrence in endometrial cancer requiring partial resection of the inferior vena cava

ObjectiveWe report the details of a surgical technique for the cytoreduction of metastatic para-aortic lymph nodes with involvement of the inferior vena cava (IVC) requiring partial resection and repair of the IVC. MethodsA 52-year-old woman presented with endometrial cancer and isolated nodal recurrence involving the IVC. A vascular clamp was applied to the segment of the IVC that the metastatic lymph nodes had involved, and an en bloc resection of the para-aortic lymph nodes with the involved segment of the IVC was performed. Results and conclusionIn this case, a partial resection of the IVC was performed to enable a complete cytoreduction without encroaching on the tumor planes. No intraoperative or postoperative complications, including vascular complications, occurred. This surgical procedure can be adopted for the management of metastatic para-aortic lymph nodes in selected patients.

Stereotactic Body Radiation Therapy (SBRT) for Pelvic or Para-Aortic Recurrence From Gynecologic Malignancies

Stereotactic Body Radiation Therapy (SBRT) for Pelvic or Para-Aortic Recurrence From Gynecologic Malignancies

PWE-312 The surgical management of isolated paraaortic lymph node recurrence following colorectal cancer resection: a case series and systematic review

Introduction Isolated paraaortic lymph-node recurrence (IPLNR) accounts for one percent of recurrent disease following colorectal cancer resection. We present a case series of patients in whom paraaortic lymphadenectomy for IPLNR following colorectal cancer was performed along with a systematic review of existing literature. Method Patients who underwent a metachronous paraaortic lymphadenectomy for IPLNR were identified retrospectively from a prospectively collected colorectal cancer database between 2005 and 2011. Demographics, surgical morbidity and long term outcome and survival were extracted. A systematic review of the literature was undertaken using three electronic databases, PUBMED, EMBASE and Google scholar following PRISMA guidelines. Additional papers were extracted from manual searches of the references. Results From the local colorectal cancer database four patients who underwent metachronous IPLNR lymphadenectomy were included. The median follow up of these patients was 20.3 months (interquartile range (IQR) 12.5–29.6 months). There were no perioperative morbidity or deaths in this cohort. One out of four patients (25%) experienced a rerecurrence at 31 months and was treated with CyberKnife TM . All patients were still alive at the end of the follow up period. Following systematic review, seven published studies were analysed. Further analysis included the four patients in this case series and 110 patients identified through systematic review (n = 114). Overall, the median follow up following surgery was 29.5 months (IQR 26.8–31.0 months). Of these patients, there were no perioperative deaths and 22 patients (19%) experienced major perioperative complications including bleeding, ileus and wound infection. Recurrences following lymphadenectomy were experienced by 64% (73/114) of patients. In those studies (5 studies) that reported 5 year overall survival, the overall survival was 50% (51/102). Conclusion The morbidity and mortality following lymphadenectomy for IPLNR is low. In carefully selected patients surgical intervention for IPLNR may be associated with improved longer term survival similar to the results seen after hepatic resection. Disclosure of interest None Declared.

Salvage laparoscopic lymphadenectomy combined to chemotherapy and/or radiation therapy for isolated para-aortic nodal recurrence of cervical cancer: Morbidity and outcomes of a case series

Salvage laparoscopic lymphadenectomy combined to chemotherapy and/or radiation therapy for isolated para-aortic nodal recurrence of cervical cancer: Morbidity and outcomes of a case series

Secondary debulking surgery for isolated para-aortic nodal recurrence in ovarian cancer involving the division of the left renal vein

ObjectiveTo present a case that involved para-aortic lymphadenectomy in the aortocaval and retrocaval region involving the division of the left renal vein (LRV). MethodsA 36-year-old woman presented with ovarian cancer and isolated nodal recurrence located in the aortocaval and retrocaval region above and below the renal vein. Cytoreduction of para-aortic lymph nodes involving the division of the LRV was performed. Results and conclusionDivision of the LRV facilitates the separation of the lymph nodes from the renal artery or inferior vena cava under direct vision. No intra- or early postoperative complications, including renal dysfunction, occurred. Further analyses with long-term follow-up are warranted to evaluate this surgical method.

Chemotherapy reduces para-aortic node recurrences in endometrial cancer with positive pelvic and unknown para-aortic nodes.

The objective of this study was to evaluate how the administration of different adjuvant therapies influences the risk for developing recurrences in the para-aortic area in endometrial cancer (EC) with positive pelvic and unknown para-aortic nodes. We retrospectively evaluated the data of 58 patients with EC affected by stage IIIC1 who had undergone pelvic but not para-aortic lymphadenectomy from January 1, 1990 to December 31, 2011. Survival outcomes within the first 5 years after surgery were assessed using the Kaplan-Meier model. Chemotherapy plus radiotherapy, chemotherapy only, and external radiotherapy only were administered in 12 (23%), 18 (34%), and 23 (43%) patients, respectively. Five (9%) patients, who were selected to forego adjuvant therapy due to poor performance status, were excluded from the analysis. Disease-free and overall survivals assessed at 5 years were 54%, and 61%, respectively. All para-aortic recurrences were observed among the patients with endometrioid EC, whereas no cases of para-aortic recurrences were found in patients with nonendometrioid histology (5/36 (14%) vs 0/17 (0%); P = 0.16); the latter were more likely to develop distant (hematogenous, peritoneal, and distant lymphatic) recurrences (P = 0.09). Type of adjuvant therapy was the only factor influencing para-aortic failure: chemotherapy (± radiotherapy) reduced the rate of para-aortic node recurrence in comparison with pelvic radiotherapy as a sole modality (P = 0.01). However, adjuvant therapy did not influence the 5-year survival outcomes (P > 0.05). In the absence of local treatment (ie, para-aortic lymphadenectomy and radiotherapy), the administration of chemotherapy seems effective in reducing recurrences in the para-aortic area among patients with stage IIIC1 endometrioid EC.

Stereotactic body radiotherapy (SBRT) in difficult-to-treat areas (para-aortic lymphadenoapthy and pelvic recurrence) in oligometastatic colorectal carcinoma.

733 Background: Oligometastatic (OM) colorectal carcinoma (defined as three or fewer sites of isolated metastatic disease) may occur in potentially difficult to treat areas (including para-aortic lymphadenopathy and pelvic recurrence). Proximity of critical structures and previous irradiation may prove treatment of OM disease challenging. The aim of this study was to identify local control, overall survival (OS), and progression free survival (PFS) of patients receiving SBRT for difficult to treat oligometastatic disease (para-aortic lymphadenopathy and pelvic recurrence). Methods: Data were prospectively collected for patients receiving SBRT between 1/9/10-31/3/14, including demographic details, SBRT date, date of local/distant progression, toxicity, and date of death. Data was collected until 1/6/14. All patients were discussed within a specialist SBRT MDT and planned for treatment utilizing the Cyberknife (Accurray) treatment system. Treatment doses included 24 Gy/3F (22.7%), 27 Gy/3F (27.3%), 30 Gy/3F (13.6%), 30 Gy/5F (4.5%), 33 Gy/3F (22.7%), 36 Gy/3F (9.1%). Total dose was determined by surrounding normal tissue toxicities. Results: 9 received SBRT for para-aortic lymphadenopathy and 13 for pelvic recurrence. Median age was 58 (38-81) years. 14 were male. Median follow-up was 8.0 (0.5-28.0) months. 59.1% patients were treated within a prior radiotherapy treatment volume. 31.8% patients were disease free after SBRT. 63.6% had distant relapse and 4.5% had local and distant relapse. Local control was 95%. Median time to relapse was 4.5 (1.2-37.2) months. OS was 72% at 1 year and 46% at 2 years. PFS was 36% at 1 year and 27% at 2 years. Significant toxicities included 1 patient with duodenal ulcer formation following para-aortic node SBRT. Conclusions: Our prospective series confirms excellent local control (95%) with SBRT for OM colorectal carcinoma in areas considered to be difficult to treat, and with limited toxicity.

Lymph node metastasis and pattern of recurrence in clinically early stage endometrial cancer with positive lymphovascular space invasion.

ObjectiveTo investigate the rate, predictors of lymph node metastasis (LNM) and pattern of recurrence in clinically early stage endometrial cancer (EC) with positive lymphovascular space invasion (LVSI).MethodsWomen with clinically early stage EC and positive LVSI 2005 to 2012 were identified. Kaplan-Meier curves and logistic regression models were used.ResultsOne hundred forty-eight women were identified. Of them, 25.7% had LNM (21.7% pelvic LNM, 18.5% para-aortic LNM). Among patients with LNM who had both pelvic and para-aortic lymphadenectomy, isolated pelvic, para-aortic and both LNM were noted in 51.4%, 17.1%, and 31.4% respectively. Age and depth of myometrial invasion were significant predictors of LNM in LVSI positive EC. Node positive patients had high recurrence rate (47% vs. 11.8%, p<0.05) especially distant (60.9% vs. 7.9%, p<0.001) and para-aortic (13.2% vs. 1.8%, p=0.017) recurrences compared to node negative EC. LNM was associated with lower progression-free survival (p=0.002) but not overall survival (p=0.73).ConclusionEC with positive LVSI is associated with high risk of LNM. LNM is associated with high recurrence rate especially distant and para-aortic recurrences. Adjuvant treatments should target prevention of recurrences in these areas.