Extended Field Radiotherapy With or Without Chemotherapy in Patients with Cervical Cancer and Positive Para-Aortic Lymph Nodes: a Single Institution Retrospective Review

Ng, Boon Huat; Rozita, AM; Adlinda, A.; Lee, Wei Ching; Zamaniah, WI Wan

doi:10.7314/apjcp.2015.16.9.3827

Cited by 3 publications

(2 citation statements)

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“…In one study, totals of 13 and 19 patients underwent EFRT and EFRT with concurrent chemotherapy. The 5-year OS rate was 40% for patients who underwent CCRT as compared to 18% for patients who had EFRT alone, with median survival of 29 and 13 months, respectively [ 35 ]. One study enrolled 46 stage IB-IVA cervical cancer patients (51.1%) who received concurrent chemotherapy.…”

Section: Treatmentmentioning

confidence: 99%

Advances in diagnosis and treatment of metastatic cervical cancer

2016

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Cervical cancer is one of the most common cancers in women worldwide. The outcome of patients with metastatic cervical cancer is poor. We reviewed the relevant literature concerning the treatment and diagnosis of metastatic cervical cancer. There are two types of metastasis related to different treatments and survival rates: hematogenous metastasis and lymphatic metastasis. Patients with hematogenous metastasis have a higher risk of death than those with lymphatic metastasis. In terms of diagnosis, fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) and PET-computed tomography are effective tools for the evaluation of distant metastasis. Concurrent chemoradiotherapy and subsequent chemotherapy are well-tolerated and efficient for lymphatic metastasis. As for lung metastasis, chemotherapy and/or surgery are valuable treatments for resistant, recurrent metastatic cervical cancer and chemoradiotherapy may be the optimal choice for stage IVB cervical cancer. Chemotherapy and bone irradiation are promising for bone metastasis. A better survival is achieved with multimodal therapy. Craniotomy or stereotactic radiosurgery is an optimal choice combined with radiotherapy for solitary brain metastases. Chemotherapy and palliative brain radiation may be considered for multiple brain metastases and other organ metastases.

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Section: Treatmentmentioning

confidence: 99%

Advances in diagnosis and treatment of metastatic cervical cancer

2016

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“…According to the previous reports regarding OS by the FIGO 2009 stage, patients in stage I with PAN involvement had 36-month OS rates of 15.6%, while patients in stages II to IV with PAN involvement had 0% OS (20). The 5-year cause-specific survival for stages I and II group of patients was 54%, and for patients with stages III and IVA was 26% (21). In patients undergoing extended field concurrent chemoradiotherapy, the 5-year OS was reported to be 50% and stages III-IV were independent predictors of lower cause-specific survival.…”

Section: Discussionmentioning

confidence: 92%

A Phase II Study of Neoadjuvant Chemotherapy Followed by Extended Field Concurrent Chemoradiotherapy for Para-aortic Lymph Node Positive Cervical Cancer

et al. 2020

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Background/Aim: We conducted a phase II study of neoadjuvant chemotherapy followed by extended field concurrent chemoradiotherapy in patients with cervical cancer with para-aortic node metastasis. Patients and Methods: Thirty-seven women with stage IB1-IVA cervical cancer were enrolled. Results: The median age was 52 years. Thirty-four patients other than 3 progressive disease, proceeded to extended field concurrent chemoradiotherapy. The 3-year overall survival and progression-free survival rates were 70.1% and 48.5%, respectively. The 3-year overall survival according to stages was significantly worse in stage IIIB. Twelve of the 17 patients with stage IIIB died of the disease. Conclusion: Neoadjuvant chemotherapy followed by extended field concurrent chemoradiotherapy may improve the prognosis of patients with stages IB and II cervical cancer with positive para-aortic node. However, new strategies should be investigated to improve a poor prognosis in stage IIIB disease with positive para-aortic node.It is currently accepted that para-aortic lymph nodes (PAN) metastasis is an important prognostic factor in patients with locally advanced cervical cancer and the existence of such is clinically very important in choosing the appropriate therapy (1). According to a Gynecologic Oncology Group (GOG) study, PAN involvement confirmed by biopsy was found in 5% of patients with the International Federation of Gynecology and Obstetrics (FIGO) stage IB, 17% of patients with stage IIB, and 25% of patients with stage IIIB. Poor survival rates were reported in these patients (2).Optimal treatment is required for cure in patients with locally advanced cervical cancer with positive PAN at the time of initial diagnosis. Several studies reported encouraging results of extended field radiotherapy for treating PAN metastasis with a 5-year overall survival ranging from 29%-50% and tolerable side effects (3-6). However, these studies warranted more research on multimodalities to further improve the prognostic results. The impact of extended field concurrent chemoradiotherapy (EF-CCRT) was studied in a few trials, with 5-year overall survival varying from 29%-39% (7-10). Some patients who underwent EF-CCRT achieved long-term remission. This is because PAN metastasis is different from other distant metastases in systemic diseases. Studies also confirmed the safety of this treatment and acceptable late toxicities despite increased acute toxicities (7). However, patients with locally advanced cervical cancer with PAN metastasis still have poor prognoses when compared with those without PAN metastasis.We conducted phase II study of neoadjuvant chemotherapy followed by EF-CCRT in patients with locally advanced cervical cancer with PAN and/or common iliac lymph nodes.

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