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Treatment outcomes of extended-field radiation therapy and the effect of concurrent chemotherapy on uterine cervical cancer with para-aortic lymph node metastasis

 Hong In Yoon  ;  Jihye Cha  ;  Ki Chang Keum  ;  Ha Yoon Lee  ;  Eun Ji Nam  ;  Sang Wun Kim  ;  Sunghoon Kim  ;  Young Tae Kim  ;  Gwi Eon Kim  ;  Yong Bae Kim 
 RADIATION ONCOLOGY, Vol.10 : 18, 2015 
Journal Title
Issue Date
Adult ; Aged ; Antineoplastic Combined Chemotherapy Protocols/therapeutic use* ; Carboplatin/administration & dosage ; Carcinoma, Large Cell/mortality ; Carcinoma, Large Cell/secondary ; Carcinoma, Large Cell/therapy* ; Carcinoma, Squamous Cell/mortality ; Carcinoma, Squamous Cell/secondary ; Carcinoma, Squamous Cell/therapy* ; Chemoradiotherapy ; Cisplatin/administration & dosage ; Female ; Follow-Up Studies ; Humans ; Lymphatic Metastasis ; Middle Aged ; Neoplasm Staging ; Para-Aortic Bodies/drug effects ; Para-Aortic Bodies/pathology* ; Para-Aortic Bodies/radiation effects ; Prognosis ; Radiotherapy Dosage ; Retrospective Studies ; Survival Rate ; Uterine Cervical Neoplasms/mortality ; Uterine Cervical Neoplasms/pathology ; Uterine Cervical Neoplasms/therapy* ; Young Adult
PURPOSE: To review the clinical outcomes of extended-field radiation therapy (EFRT) and to analyze prognostic factors significant for survival in patients receiving EFRT for uterine cervical carcinoma with para-aortic node (PAN) metastasis.

PATIENTS AND METHODS: We retrospectively reviewed 90 patients with stage IB-IVA cervical cancer and PAN metastasis between 1987 and 2012. Median age was 50 (range, 24-77). Patients received median 70.2 Gy (range, 56-93) to point A and median 50.4 Gy (range, 45-60.4) to PAN over median 69 elapsed days (range, 43-182). Forty-six patients (51.1%) received concurrent chemotherapy. Survival was calculated using the Kaplan-Meier method. We analyzed prognostic factors for overall actuarial survival (OS) and progression-free survival (PFS) using a Cox regression method.

RESULTS: The median follow-up period for surviving patients was 55 months (range, 3-252). Seventy patients (77.8%) had complete remission. Forty-six patients experienced treatment failure as follows: 11 patients (12.2%) as local recurrence, 19 (21%) as regional recurrence and 33 (36.7%) as distant metastasis. The 5-yr OS and PFS were 62.6% and 43.9%, respectively. Treatment response was the only statistically independent prognostic factors for OS (p= 0.04) and PFS (p< 0.001) on multivariate analysis. Grade 3 or 4 hematologic gastrointestinal and urogenital toxicities were observed in about 10% of patients.

CONCLUSIONS: Our institutional experiences showed that EFRT was an effective treatment for cervical cancer patients with PAN metastasis. The addition of chemotherapy to EFRT seems to have uncertain survival benefit with higher hematologic toxicity.
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1. College of Medicine (의과대학) > Dept. of Obstetrics and Gynecology (산부인과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Pharmacology (약리학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiation Oncology (방사선종양학교실) > 1. Journal Papers
Yonsei Authors
Keum, Ki Chang(금기창) ORCID logo https://orcid.org/0000-0003-4123-7998
Kim, Gwi Eon(김귀언)
Kim, Sang Wun(김상운) ORCID logo https://orcid.org/0000-0002-8342-8701
Kim, Sung Hoon(김성훈) ORCID logo https://orcid.org/0000-0002-1645-7473
Kim, Young Tae(김영태) ORCID logo https://orcid.org/0000-0002-7347-1052
Kim, Yong Bae(김용배) ORCID logo https://orcid.org/0000-0001-7573-6862
Nam, Eun Ji(남은지) ORCID logo https://orcid.org/0000-0003-0189-3560
Yoon, Hong In(윤홍인) ORCID logo https://orcid.org/0000-0002-2106-6856
Cha, Ji Hye(차지혜)
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