title: Radiation therapy for carcinoma of the cervix with biopsy-proven positive para-aortic lymph nodes.
abstract: OBJECTIVE
  To evaluate local tumor control, cause-specific survival, patterns of relapse, and toxicity in patients with cervical cancer and positive para-aortic lymph nodes treated with radiation therapy alone.
  
  
  METHODS
  This is a retrospective chart review of 43 patients with cervical cancer and biopsy-proven positive para-aortic lymph nodes treated with radiation therapy treated from 1965 to 1993. There were 15 patients with clinical Stage I disease, 12 with Stage II, and 16 with Stage III. Patients were treated with external irradiation to the pelvis and para-aortic regions combined with brachytherapy. None received chemotherapy.
  
  
  RESULTS
  The 5-year overall survival rate was 32% and the median overall survival was 2.2 years. The 5-year cause-specific survival rate was 49% and the median cause-specific survival was 2.7 years. The cause-specific survivals at 5 years were 47% for Stage I, 64% for Stage II, and 46% for Stage III. Tumor recurrence occurred in 20 patients. The sites of recurrence were in the pelvis only in 3, the pelvis and distant metastasis in 9, and distant metastasis only in 8 patients. Severe, grade 3 complications occurred in 2 patients. One patient developed an enterovaginal fistulas and 1 developed radiation myelitis.
  
  
  CONCLUSIONS
  Pelvic and para-aortic irradiation and brachytherapy resulted in a 49%, 5-year, cause-specific survival. Clinical tumor stage did not effect outcome. The majority of relapses occurred at distant sites. Toxicity was acceptable. Systemic chemotherapy should be considered as adjunctive therapy for these patients.
authors.affiliation: Radiation Oncology Center, Mallinckrodt Institute of Radiology, St. Louis, MO 63110, USA. grigsbyp@netscape.net
authors.forename: P W
authors.initials: PW
authors.lastname: Grigsby
authors.forename: C A
authors.initials: CA
authors.lastname: Perez
authors.forename: K S
authors.initials: KS
authors.lastname: Chao
authors.forename: T
authors.initials: T
authors.lastname: Herzog
authors.forename: D G
authors.initials: DG
authors.lastname: Mutch
authors.forename: J
authors.initials: J
authors.lastname: Rader
mesh_terms: D000328:Adult; D000368:Aged; D001011:Aorta; D001706:Biopsy; D001918:Brachytherapy; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D015182:Lymphatic Irradiation; D008875:Middle Aged; D009367:Neoplasm Staging; D011832:Radiation Injuries / Q000209:etiology / Q000473:pathology; D012189:Retrospective Studies; D015996:Survival Rate; D002583:Uterine Cervical Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*