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.
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.