Introduction/Background LACC is made up of very different patients treated for decades the same. The prognosis is still not good, especially in those with para-aortic nodal involvement. Its stratification based on thrisk of para-aortic nodal involvement is necessary for better management and prognostic improvement. The clinical-pathological patterns and factors associated with recurrences allow us to predict the risk of these as well a adapt our diagnostic therapeutic and follow-up protocols.

Methodology Retrospective analysis of 196 patients treated with concurrent chemoradiotherapy limited to pelvis (CCRT-P) (n=160) and para-aortic extended field radiotherapy with pelvic chemoradiation (CCRT-P+PAO) (n=36) where the clinical-pathological patterns and factors associated with recurrences were analyzed. In addition, the impact of the local-regional control (LRC) and an added analysis of the patterns and clinical-pathological factors once patients with an inadequate LRC were excluded (n=141).

Results Recurrences in CCRT-P+PAO group were lower (p=0.73;0.10;0.6, for distant (DR), para-aortic (PAOR) and both (D+PAO-R) respectively . Median to recurrence of 4.6 and 7 months for local-regional recurrences (LRR), DR and PAOR in the CCRT-P, and 10 months for total recurrences in the CCRT-P+PAO group. OS in the CCRT-P group was higher (p=0.14). In the CCRT-P group, the presence of >1 pelvis node and the absence of LRC were independent prognostic factors for DR and D+PAO-R (HR 2.42, IC 95% [1.4–4.8], p=0.012 and HR 2.4, IC 95% [1.06–4], p=0.033), and for all types of recurrences respectively (HR 21.8, IC 95% [9.9–47]; HR 8.14, IC 95% [3.1–2.1]; HR 21.2, IC 95% [10.1–44] for DR, PAOR and D+PAO-R, with p<0.000 in all types). OS was lower in patients with CCRT-P with >1 pelvic node (p<0.000) and inadequate LRC (p=0.023). Recurrences and median to recurrence in CCRT-P and adequate LRC group (n=141) was 16.3%, and 29 and 30 months for RAD and RPAO. After multivariate analysis, in the CCRT-P and adequate LRC group, a tumor size of ≥4 cm was associated as an independent prognostic factor for DR (HR 2.7, IC 95% [1.04–7], p=0.032). OS was lower in patients with a tumor of ≥4 cm in this group (p=0.12).

Conclusion There are different patterns of recurrence in LACC between those treated with CCRT-P and CCRT-P+PAO, that allows us to provide for the risk of these and adapt our diagnostic-therapeutic and follow-upprotocols. LACC patients treated with CCRT-P have clinical-pathological factors associated with recurrences that allow us to provide for the risk of these as well as adapt our diagnostic-the rapeutic and follow-upprotocols.