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

Abstract

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.

Extended-Field Intensity-Modulated Radiotherapy and Concurrent Cisplatin-Based Chemotherapy for Postoperative Cervical Cancer With Common Iliac or Para-Aortic Lymph Node Metastases: A Retrospective Review in a Single Institution

“…10,16 In the present study, we found the OS rate to be 71.5%, which compares favorably with those reported in previous studies. 10,16 Extended-field IMRT concomitant with chemotherapy was effective in preventing in-field failure. The locoregional in-field control rate was good, with distant sites being the most common sites of failure.…”

“…Because Kim et al 10 reported that the addition of concurrent chemotherapy to postoperative EFRTwas superior to the use of radiation alone in patients with a pathologically confirmed PAN or CIN metastasis, postoperative EFRT combined with chemotherapy was considered in patients with a pathologically confirmed PAN or CIN metastasis in our institution. Very few studies have suggested the remedial model of postoperative EFRT with concurrent chemotherapy.…”

“…9 A previous study has demonstrated that the use of concurrent chemotherapy and postoperative EFRT significantly improved the 5-year OS rate (61%) and the 5-year disease-free survival (DFS) rate (54%), but high rates of toxicity were observed. 10 As a means of reducing toxicity, intensity-modulated radiotherapy (IMRT) has been shown to decrease the incidence of acute and late gastrointestinal toxicities. Jensen et al 11 demonstrated that extended-fielded IMRT was associated with low rates of acute gastrointestinal toxicities, late toxicity, and locoregional failure.…”

Time for global efforts with clinical trials for advanced cervical cancer patients

“…This result brought up the idea that initial molecular evaluation of primary tumor tissue could be helpful in selecting appropriate and individualized drugs for better tumor response to CCRT and with fewer complications possibly in advanced cervical cancer. An article by Kim et al 5 in this issue reports that concurrent extended field radiation and chemotherapy improved 5 year survival rate of 61% in patients with metastatic para-aortic nodes in early stage cervical cancer compared to postoperative radiation only. A recent report with concurrent paclitaxel and cisplatin during extended field radiation in patients with pos-itive paraaortic nodes and locally advanced stage cervical cancer showed promising results with improved survival rate of 56% at the time of report.…”

“…In this issue of Journal of Gynecology Oncology, there are 3 articles dealing with cervical cancer either with locally advanced tumor or with metastatic nodes at paraaortic region found at the time of operation. [3][4][5] Radiation has been the primary treatment modality for locally advanced cervical cancer (FIGO stage IB2-IVA). Weekly cisplatin is a standard one as a concurrent chemo-radiotherapy with improved local control and survival.…”