J Gynecol Oncol.  2012 Jul;23(3):159-167. 10.3802/jgo.2012.23.3.159.

Radiation therapy with chemotherapy for patients with cervical cancer and supraclavicular lymph node involvement

• Lee SH
• Lee SH
• Lee KC
• Lee KB
• Shin JW
• Park CY
• Sym SJ
• Lee JH

• KMID: 2245174
• DOI: http://doi.org/10.3802/jgo.2012.23.3.159

Abstract

OBJECTIVE
We wanted to evaluate the outcomes of cervical cancer patients with supraclavicular lymph node (SCLN) involvement and who received radiation therapy (RT) combined with chemotherapy.
METHODS
From August 2001 to April 2009, nine cervical cancer patients with SCLN involvement were treated by RT and cisplatin-based chemotherapy. Most of the patients (8/9, 88.9%) also had a positive para-aortic lymph node (PALN). The RT field was designed to include the whole pelvis, the involved PALNs and the SCLN area. The median SCLN RT dose was 66.6 Gy (range, 60 to 70 Gy).
RESULTS
The median follow-up period was 61 months (range, 13 to 98 months). The 3- and 5-year overall survival rates were 66.7% and 55.6%, respectively and the 3- and 5-year progression-free survival rates were 66.7% and 44.4%, respectively. The acute hematologic toxicities according to the criteria of Radiation Therapy of Oncology Group (RTOG) were G1/2 leucopenia in 3 (33.3%), G3/4 leukopenia in 6 (66.7%), G1/2 anemia in 7 (77.8%), G3 anemia in 1 (11.1%), G2 thrombocytopenia in 2 (22.2%), and G3/4 thrombocytopenia in 2 (22.2%). Within 6 months after RT, most of the patients (5/6, 83.3%) recovered from the G3/4 leukopenia, except for 1 patient who received chemotherapy after completing RT due to subsequent bone metastasis.
CONCLUSION
For patients with advanced cervix cancer and SCLN involvement, RT with chemotherapy as active therapy can be expected to provide favorable results, although there is an increased risk of G3/4 hematologic toxicity.

Keyword

Cervical cancer; Chemotherapy; Radiation therapy; Supraclavicular lymph node

MeSH Terms

Anemia
Disease-Free Survival
Follow-Up Studies
Humans
Leukopenia
Lymph Nodes
Pelvis
Survival Rate
Thrombocytopenia
Uterine Cervical Neoplasms

Figure

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  Fig. 1 The three-dimensional conformal radiation therapy fields generated by the treatment-planning computer. (A) The four field plan for the pelvis and para-aortic lymph node radiation therapy (RT). (B) The supraclavicular lymph node conventional RT plan and the image showing the isodose distribution.

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  Fig. 2 An example case with multiple para-aortic and left supraclavicular lymph node metastases. A 49-year-old woman who was diagnosed as having uterine cervix cancer with coincidental para-aortic and left supraclavicular lymph node metastases (A, on December 2003) underwent concurrent chemotherapy and radiation therapy with the extended 4 field technique, followed by the supraclavicular one port source-to-skin distance technique. The patient is now on regular follow-up without any evidence of recurrence (B, after treatment on June 2006).

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  Fig. 3 Progression-free survival (PFS) and overall survival (OS) of performing concurrent chemoradiation therapy for cervical cancer with supraclavicular involvement at the initial presentation.

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  Fig. 4 Example of a case with right supraclavicular lymph node metastasis (A, before treatment). The patient underwent concurrent chemotherapy and radiation therapy by the supraclavicular one port source-to-skin distance technique. On regular follow-up, the right supraclavicular lymph node metastasis disappeared (B, after treatment).

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