Cervical carcinoma metastatic to para-aortic nodes: extended field radiation therapy with concomitant 5-fluorouracil and cisplatin chemotherapy: a gynecologic oncology group study

Varia, Mahesh A.; Bundy, Brian N.; Deppe, Gunter; Averette, Hervy E.; Rose, Peter G.; Connelly, Jon P.

doi:10.1016/s0360-3016(98)00267-3

Cited by 203 publications

(136 citation statements)

References 33 publications

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“…Though all patients did experience acute GI toxicity from treatment, this toxicity was considerably less severe than in previous chemoradiation series that employed conventional techniques to treat para-aortic volumes. 15,16 Oneand 2-year disease free survival of 60.0% and 38.1% were similar to those reported in previous studies of extended field radiation and again demonstrated that a subset of women with para-aortic node positive cervical cancer may be cured. 15 Patterns of failure revealed that the majority of patients who failed had distant disease as a component of recurrent disease.…”

Section: Discussionsupporting

confidence: 88%

“…15,16 Oneand 2-year disease free survival of 60.0% and 38.1% were similar to those reported in previous studies of extended field radiation and again demonstrated that a subset of women with para-aortic node positive cervical cancer may be cured. 15 Patterns of failure revealed that the majority of patients who failed had distant disease as a component of recurrent disease. Importantly, no patients developed recurrence or major side effects near the dynamic match junction.…”

Section: Discussionsupporting

confidence: 88%

“…Prospective phase II cooperative group trials with chemoradiation and conventionally treated para-aortic volumes have reported unacceptably high rates of grade 3 and 4 acute and late toxicities. 15,16 Therefore, improvement upon conventional technique has been necessary to reduce associated toxicity.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

A novel dynamic field-matching technique for treatment of patients with para-aortic node-positive cervical cancer: Clinical experience

Baden

Whitley

López-Araujo

et al. 2016

Reports of Practical Oncology & Radiotherapy

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Section: Discussionsupporting

confidence: 88%

Section: Discussionsupporting

confidence: 88%

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A novel dynamic field-matching technique for treatment of patients with para-aortic node-positive cervical cancer: Clinical experience

Baden

Whitley

López-Araujo

et al. 2016

Reports of Practical Oncology & Radiotherapy

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“…In two prospective randomized studies, this approach has been used to evaluate treatment outcomes. 8,9 The reported survival rates at two to three years as determined from these studies were approximately 39% to 47%, but high rates of toxicity were observed. 8,9 Contrary to these studies where EFRT with or without CTx was used with a curative purpose, few studies have investigated the use of postoperative EFRT (POEFRT).…”

Section: Introductionmentioning

confidence: 83%

Treatment outcomes and prognostic factors in uterine cervical cancer patients treated with postoperative extended field radiation therapy

Kim

2009

J Gynecol Oncol

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Objective: To evaluate treatment outcomes and prognostic factors in uterine cervical cancer patients treated with postoperative extended field radiation therapy (POEFRT) with or without chemotherapy. Methods: Between 1983 and 2006, 35 patients with a pathologically confirmed positive para-aortic node (PAN) or common iliac node (CIN) who underwent a radical hysterectomy with bilateral pelvic lymph node dissection and PAN dissection received POEFRT with (N=23) or without (N=12) chemotherapy. Prognostic factors such as age, stage, size, parametrium invasion, lymphovascular space invasion, nodal station, depth of stromal invasion and use of chemotherapy were analyzed. Results: With a median follow-up of 44 months, the 5-year overall survival (OS), disease-free survival (DFS), distant failure-free survival (DFFS) and loco-regional failure-free survival rates were 51%, 51%, 59% and 93%, respectively. The use of chemotherapy significantly improved the 5-year OS rate (61% vs. 48%, p=0.004), the 5-year DFS rate (54% vs. 38%, p=0.004) and the 5-year DFFS rate (57% vs. 48%, p=0.009). PAN involvement resulted in a compromised 5-year DFS rate (42% vs. 73%, p=0.002) and 5-year DFFS rate (47% vs. 82%, p=0.004) as compared to CIN involvement. Grade 3 or higher hematological toxicity was observed more frequently in patients who received POEFRT combined with chemotherapy as compared to patients who received POEFRT alone (52% vs. 17%, p=0.04). Conclusion:The use of POEFRT resulted in an excellent loco-regional control rate. The addition of chemotherapy may improve outcome in patients who have received POEFRT, but with higher manageable toxicity.

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“…In particular, para-aortic nodal status has been shown to be the most powerful parameter for patient outcomes [25,26]. On the other hand, the recent introduction of combined therapies including radiation therapy plus sensitising chemotherapy gives rise to rational hopes in terms of prolonged survival [27,28,29]. So far, among the available diagnostic tools that are recommended by the FIGO staging system for the assessment of nodal status, neither lymphangiography, computed tomography (CT) nor MRI are sensitive enough for the accurate detection of nodal metastases [2,4,5,30].…”

Section: N Stagingmentioning

confidence: 99%

Whole-body 18FDG PET plus pelvic MRI in the pre-treatment assessment of cervical cancers: an alternative to the FIGO clinical staging

Belhocine

2004

Gynecol Surg

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Growing evidence indicates that whole-body 18 F-fluorodeoxyglucose positron emission tomography (wb-18 FDG PET) plus pelvic magnetic resonance imaging (pMRI) may significantly improve the pre-treatment staging of primary cervical cancers. Such a combined protocol provides complementary insights into primary tumour delineation, loco-regional involvement and distant spread. As such, pMRI appears particularly reliable for the accurate measurement of tumour size, the detection of parametrial invasion and, even more so, for its exclusion. So far, wb-18 FDG PET yields unique information about extra-pelvic nodal and visceral tumour status. Of note, however, is the limitation of both imaging techniques for the detection of microscopic pelvic lymph node metastases, especially in early stage disease. Promising data also highlight the prognostic value of 18 FDG uptake as a marker of disease aggressiveness and of tumour resistance to treatment. The recent development of combined PET-CT scans as well as the validation of the sentinel node concept in gynaecological malignancies may grant new perspectives for optimal management of cervical cancers in the pre-treatment setting.

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Cervical carcinoma metastatic to para-aortic nodes: extended field radiation therapy with concomitant 5-fluorouracil and cisplatin chemotherapy: a gynecologic oncology group study

Cited by 203 publications

References 33 publications

A novel dynamic field-matching technique for treatment of patients with para-aortic node-positive cervical cancer: Clinical experience

A novel dynamic field-matching technique for treatment of patients with para-aortic node-positive cervical cancer: Clinical experience

Treatment outcomes and prognostic factors in uterine cervical cancer patients treated with postoperative extended field radiation therapy

Whole-body 18FDG PET plus pelvic MRI in the pre-treatment assessment of cervical cancers: an alternative to the FIGO clinical staging

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