title: Isolated paraaortic lymph node recurrence after definitive irradiation for cervical carcinoma.
abstract: OBJECTIVE
  To evaluate the clinical features of isolated paraaortic lymph node (PALN) recurrence after definitive radiotherapy, and analyze the prognostic factors and effect of salvage treatment.
  
  
  METHODS
  Of a total 876 patients who received pelvic radiotherapy after the diagnosis of primary cervical carcinoma, 26 were found to have isolated PALN recurrence as the first recurrent site, and these patients enrolled in this study. Only those with primary-site carcinoma controlled and who were free of other distant metastases were eligible. Nineteen of the 26 patients accepted salvage therapy. Fourteen patients accepted concurrent chemoradiation (CCRT), 1 accepted radiation to the paraaortic region, and 4 accepted chemotherapy alone. Clinical parameters evaluated included tumor markers (SCC and CEA) and image studies.
  
  
  RESULTS
  Seven of the 26 patients were alive and disease-free. All 7 survivors had salvage treatment with radiation to the paraaortic region and concurrent cisplatin-based chemotherapy. None of the patients receiving chemotherapy or radiation alone enjoyed long-term, disease-free survival. The 5-year survival rate for isolated PALN recurrence of the 14 patients who accepted salvage concurrent chemoradiation (CCRT) was 51.2%. The presence of a clinical symptom at the time of PALN recurrence was analyzed. Seven of the 12 asymptomatic patients and none of the 14 symptomatic patients survived without disease after salvage treatment. The SCC levels at recurrence showed a statistically significant relationship to disease-free survival.
  
  
  CONCLUSIONS
  An SCC level of < or = 4 ng/ml and a lack of symptoms at the time of recurrence were good prognostic factors in isolated PALN recurrence after primary radiation therapy. In addition to concurrent CCRT, periodical surveillance with tumor markers and imaging studies allowed early detection and salvage of those patients.
authors.affiliation: Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Chang Gung Memorial Hospital, Taoyuan, Taiwan. ma2012@adm.cgmh.org.tw
authors.forename: H H
authors.initials: HH
authors.lastname: Chou
authors.forename: C C
authors.initials: CC
authors.lastname: Wang
authors.forename: C H
authors.initials: CH
authors.lastname: Lai
authors.forename: J H
authors.initials: JH
authors.lastname: Hong
authors.forename: K K
authors.initials: KK
authors.lastname: Ng
authors.forename: T C
authors.initials: TC
authors.lastname: Chang
authors.forename: C J
authors.initials: CJ
authors.lastname: Tseng
authors.forename: C S
authors.initials: CS
authors.lastname: Tsai
authors.forename: J T
authors.initials: JT
authors.lastname: Chang
mesh_terms: D000328:Adult; D000368:Aged; D000951:Antigens, Neoplasm / Q000032:analysis; D001011:Aorta; D002272:Carcinoembryonic Antigen / Q000032:analysis; D002294:Carcinoma, Squamous Cell / Q000097:blood / Q000473:pathology / Q000532:radiotherapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D011879:Radiotherapy Dosage; D012008:Recurrence; D016879:Salvage Therapy; D015843:Serpins; D016019:Survival Analysis; D002583:Uterine Cervical Neoplasms / Q000097:blood / Q000473:pathology / Q000532:radiotherapy*
chemical_list: D000951:Antigens, Neoplasm; D002272:Carcinoembryonic Antigen; D015843:Serpins; C051072:squamous cell carcinoma-related antigen