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Extended field chemoradiation for cervical cancer patients with histologically proven para-aortic lymph node metastases after laparaoscopic lymphadenectomy.
- Source :
-
Strahlentherapie und Onkologie : Organ der Deutschen Rontgengesellschaft ... [et al] [Strahlenther Onkol] 2015 May; Vol. 191 (5), pp. 421-8. Date of Electronic Publication: 2014 Nov 21. - Publication Year :
- 2015
-
Abstract
- Background and Purpose: The purpose of this work was to evaluate the use of extended-field chemoradiation (EFRT) with concomitant chemotherapy in patients with histologically confirmed para-aortic metastases after laparoscopic para-aortic and pelvic lymphadenectomy (LAE) with regard to oncologic results and treatment-related toxicity.<br />Patients and Methods: A total of 44 women with squamous cell carcinoma (82 %) and adenocarcinoma (18 %) of the cervix in FIGO stages IIA (n = 3), IIB (n = 29); IIIB (n = 9), and IVA (n = 3) and histologically proven para-aortic metastases underwent EFRT and chemotherapy. Laparoscopic LAE was performed in 40 patients. Patients underwent chemoradiation with conventional fractionation of 1.8-50.4 Gy to the para-aortic and pelvic region. In addition, MRI-guided brachytherapy was performed to the cervix with 5-6 single doses of 5 Gy for a total dose of 25-30 Gy.<br />Results: The mean number of harvested lymph nodes was 17 in the pelvic as well as para-aortic regions, respectively. Laparoscopic intervention did not delay chemoradiation. Follow-up was 6-76 months (mean 25.1 months). There was no grade 4 or 5 acute radiation toxicity. In all, 8, 4, and 11 % grade 1, 2, and 3 gastrointestinal late toxicities and 7, 11, and 19 % grade 1, 2 and 3 genitourinary late toxicities were recorded. Despite the excellent locoregional (pelvic) control rates of 89.1 and 82.8 % after 2 and 5 years, respectively, the overall survival rates were 68.4 and 54.1 % after 2 and 5 years, respectively. Of the 44 patients, 43 remained tumor free in the para-aortic region.<br />Conclusion: In patients with proven para-aortic disease, excellent pelvic and para-aortic control could be achieved by laparoscopic LAE followed by EFRT. More than half of the patients were long-term survivors. The high risk of distant metastases should be addressed by further improving systemic treatment.
- Subjects :
- Adenocarcinoma mortality
Adult
Aged
Brachytherapy methods
Carcinoma, Squamous Cell mortality
Combined Modality Therapy
Dose Fractionation, Radiation
Female
Follow-Up Studies
Humans
Magnetic Resonance Imaging methods
Middle Aged
Neoplasm Grading
Neoplasm Staging
Radiotherapy, Image-Guided methods
Survival Rate
Uterine Cervical Neoplasms mortality
Adenocarcinoma pathology
Adenocarcinoma therapy
Carcinoma, Squamous Cell pathology
Carcinoma, Squamous Cell therapy
Chemoradiotherapy methods
Chemoradiotherapy, Adjuvant methods
Laparoscopy
Lymph Node Excision
Lymphatic Metastasis pathology
Uterine Cervical Neoplasms pathology
Uterine Cervical Neoplasms therapy
Subjects
Details
- Language :
- English
- ISSN :
- 1439-099X
- Volume :
- 191
- Issue :
- 5
- Database :
- MEDLINE
- Journal :
- Strahlentherapie und Onkologie : Organ der Deutschen Rontgengesellschaft ... [et al]
- Publication Type :
- Academic Journal
- Accession number :
- 25413986
- Full Text :
- https://doi.org/10.1007/s00066-014-0785-z