Uterine cervix cancer
The size of the metastatic lymph node is an independent prognostic factor for the patients with cervical cancer treated by definitive radiotherapy

https://doi.org/10.1016/j.radonc.2013.04.015Get rights and content

Abstract

Background and purpose

Lymph node (LN) metastasis is a well-known prognostic factor of the cervical cancer. In the current study, the size of metastatic LN was evaluated for its significance in the patients treated with definitive radiotherapy.

Materials and methods

LN metastasis was evaluated for the 268 consecutive patients. The short-axis diameters of the largest LN were measured on magnetic resonance images for the 155 patients with LN metastasis. All the patients were classified into three groups: the negative lymphadenopathy (group N), the small (<15 mm) lymphadenopathy (group SP), and the large (⩾15 mm) lymphadenopathy (group LP).

Results

Patients in the group LP showed significantly lower survival rates than the groups N and SP (5-year overall survival rates of 89%, 82%, and 58%, for groups N, SP, and LP, respectively, P < 0.001; 5-year disease-free survival rates of 80%, 67%, and 50%, respectively, P < 0.001). Regarding the pattern of failure, patients in the group LP showed inferior regional control rates and higher distant metastasis.

Conclusion

The current study shows that the patients with large metastatic LNs are at increased risk of dying from early distant metastasis with substantial number of combined regional failures. Adoption of more effective systemic treatment as well as high radiotherapy dose for LNs may improve cure rates for these patients.

Section snippets

Patients

The medical records of 274 consecutive cervical cancer patients treated with definitive radiotherapy from August 2003 to April 2008 at the National Cancer Center, Korea, were reviewed. Six patients were excluded from the analysis for the following reasons. Patients who did not undergo brachytherapy (n = 2) were excluded; one patient who suffered grade 3 acute gastrointestinal toxicity from the external beam radiotherapy refused further treatment, and one other patient who showed partial response

Lymph node size and treatment outcomes

At diagnosis, 57% (155/270) of the patients had metastatic LN based on the imaging studies. Of these, 36.8% (57/155) had lymph nodes with a short axis of 15 mm or greater. Fig. 1 shows the overall survival rate respective to the LN group by size. There was a significant decrease in the survival rate as LN size increases over 1.5 cm. When patients with LN size ⩾1.5 cm were further divided into 3 size categories (1.5–2 cm, 2–3 cm, ⩾3 cm), there was no significant difference in the survival rate within

Discussion

Definitive radiotherapy with cisplatin-based concurrent chemotherapy is the most widely performed treatment method for patients with locally advanced cervical cancer. Considering that the non-operative treatment approach is more frequently used in this disease, accurate clinical staging is of utmost importance in predicting the prognosis and in individualizing the treatment method of cervical cancer. LN metastasis can be most accurately determined by surgical biopsy; however, radiologic images

Acknowledgement

This study was supported by Grant No. 1110540 from the National Cancer Center, Korea (Dr. Kim).

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