J Gynecol Oncol.  2013 Jul;24(3):229-235. 10.3802/jgo.2013.24.3.229.

Prognostic factors and treatment outcome after radiotherapy in cervical cancer patients with isolated para-aortic lymph node metastases

• Jang H
• Chun M
• Cho O
• Heo JS
• Ryu HS
• Chang SJ

• KMID: 2288529
• DOI: http://doi.org/10.3802/jgo.2013.24.3.229

Abstract

OBJECTIVE
The purpose of the present study was to evaluate treatment outcomes and prognostic factors in cervical cancer patients with isolated para-aortic lymph node (PALN) metastases. We especially tried to evaluate PALN factors such as size, site and number.
METHODS
From August 1994 to December 2009, 40 cervical cancer patients with isolated PALN node metastases at initial diagnosis were selected for analysis. Patients underwent both extended field external beam and intracavitary brachytherapy. Fourteen patients received 5-fluorouracil and cisplatin (FP) and 16 patients received weekly concurrent cisplatin. Information of PALN, such as size, site, and number, was founded before PALN radiotherapy.
RESULTS
The median follow-up time after primary treatment was 28.5 months (range, 2 to 213 months). The 3-year overall and progression-free survival rate after primary treatment was 44.3% and 31.3%, respectively. In multivariate analysis including tumor stage, performance status, and chemotherapy, FP regimen concurrent chemoradiotherapy was more effective than radiotherapy alone (p=0.030). The 3-year progression-free survival rate was 41.9% and 11.1% in patients with PALN numbers of < or =1 and > or =2, respectively (p=0.008). The 3-year progression-free survival rate was 42.1% and 19.2% in patients with PALN size of <1.5 cm and > or =1.5 cm, respectively (p=0.031).
CONCLUSION
The radiologic features of PALN, such as number or size, can be used to determine prognosis in PALN metastatic cervical cancer patients. Furthermore, FP regimen concurrent chemoradiotherapy was associated with better patient survival than radiotherapy alone. However, more studies are required to confirm possible different treatment outcomes between FP and weekly cisplatin regimens.

Keyword

Cervical cancer; Para-aortic lymph node; Radiotherapy

MeSH Terms

Brachytherapy
Chemoradiotherapy
Cisplatin
Disease-Free Survival
Fluorouracil
Follow-Up Studies
Humans
Lymph Nodes
Multivariate Analysis
Neoplasm Metastasis
Prognosis
Treatment Outcome
Uterine Cervical Neoplasms
Cisplatin
Fluorouracil

Figure

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  Fig. 1 Overall and progression-free survivals of patients.

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  Fig. 2 Progression-free survival rate according to number of para-aortic lymph nodes (PALN).

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  Fig. 3 Progression-free survival rate according to size of para-aortic lymph nodes (PALN).

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