Objectives Cervical cancer (CC) with exclusive para-aortic lymph node involvement (PALN) treatment is controversial. We analyzed long-term results and adverse events (AE) of chemoradiotherapy with extended field to PALN+brachytherapy (BCT).

Methods This was a single center, retrospective study. Patients diagnosed between 2008–2015 with IIIC2 FIGO stage squamous (SCC), adeno or adenosquamous CCPALN, confirmed by CT scans or MRI. All had chemotherapy+pelvic conformational radiotherapy (CRT)±brachytherapy (BCT)±extended PALNRT. Overall survival (OS) and progression free survival (PFS) were analyzed by Kaplan-Meier and log-rank test.

Results 38 pts were analyzed, median age 53.5 yo, 42.2% poor education, 68.4% white, 42.1% pre-menopausal, 28.9% smokers, 34 (89.5%) SCC. Tumor size: 11 (28.9%) IIB, 11 (39.5%) III, 15 (39.5%) IV; 31 ECOG 0–1. 34 pts received CRT, 29 parametrial boost (9–14,4Gy), 28 extend PALN RT. OS 18.7m (±2.978), PFS 12.0m (±1.7). Comorbidities and tumor size had no impact in OS or PFS. There was significant longer OS in pts that received ≥45Gy (28.9 m vs 18.7 m, p=0.031) and pts that had BCT (36.8 m vs 13.6 m, p=0,009). LNPA extended field had a trend to detrimental effect (OS 17.7 m vs 29.9 m, p=0.456). AE: 12 leukopenia, 8 asthenia, 4 neuropathy, 3 cystitis/enteritis, 7 fistula.

Conclusions In this retrospective study, effective localized RDT (at least 45Gy in pelvis+BCT) was associated with better OS. Extended field to PALN+brachytherapy (BCT) had no benefit and was associated with a trend to worst outcome and higher incidence of serious adverse events, even with conformational technics. Prospective randomized studies are necessary to confirm this data.