The Outcomes of Extended Field Radiotherapy in Patients with Para-aorticLymph Node Metastases of Cervical Cancer

Abstract

Purpose: Patients with advanced cervical cancer require interdisciplinary therapeutic treatment, after detailed diagnostics (CT, MR and also PET/CT), due to the high risk of metastases to the pelvic lymph nodes and/or paraaortic lymph nodes as well as supraclavicular region. Aim: The aim of this retrospective study was to assess the response to treatment in women with cervical cancer with metastases to the para-aortic lymph nodes given radiotherapy or radiochemotherapy Material and Methods: The study was conducted in 40 cervical cancer patients with para-aortic lymph node metastases undergoing radiation therapy with/whitout concomitantly a cisplatin-based chemotherapy. Subsequently, total doses were set for pelvic lymph nodes and para-aortic lymph nodes, and were between 45 and 50.4Gy with dose increase to the tumor and metastatic lymph nodes for a total dose of 48.6-60Gy in 1.8 to 2.0Gy fractionation. Results: The analysis of overall survival demonstrates that OS was significantly longer in patients with local reccurence (p=0.0165) or distant metastases (p=0.0266) as compared to patients without reccurence or dissemination. An effect on overall survival (OS) was observed of emergency radiation therapy (p=0.026) but we did not observe anything particular for emergency chemotherapy. The analysis of disease-free survival time included the assessment of various parameters using the log-rank test to demonstrate that DFS was significantly longer in patients without local recurrence (p=0.0452) and distant metastases (p<0.0001) as compared to patients with dissemination. It was demonstrated that the presence of metastases caused a significantly higher risk of non-remission (OR = 42.5; +/- 95% CI: 4.58-394.45; p = 0.001), and the recurrence of the disease reduced the chance of remission (OR = 0.35; +/- 95% CI: 0.15-0.83; p = 0.016). Conclusion: It is well-known that our study has several limitations which could have influenced the results we obtained, including the small number of patients and a non-homogeneous group: some patients were operated on prior to radiotherapy +/- chemotherapy, therefore it is advisable to continue testing on larger groups of patients.