title: Hyperfractionated radiotherapy with concurrent chemotherapy for para-aortic lymph node recurrence in carcinoma of the cervix.
abstract: OBJECTIVE
  To evaluate efficacy, toxicity, and patterns of relapse in patients treated with hyperfractionated radiotherapy (HFRT) with concurrent chemotherapy for para-aortic lymph node (PALN) recurrence of cervical carcinoma.
  
  
  METHODS
  Between September 1997 and October 2000, 12 cervical carcinoma patients with isolated PALN recurrence who had previously received radical or postoperative radiotherapy were treated with HFRT and concurrent chemotherapy. The initial FIGO stage was Stage IB in 4 (33%) patients, Stage IIA in 2 (17%), and Stage IIB in 6 (50%). The radiation field encompassed the gross recurrent PALN with the superior margin at the upper end of the T12 body and the inferior margin between L5 and S1. The fractionated dose was 1.2 Gy in 2 daily fractions, and the median total dose was 60 Gy. The weekly concurrent chemotherapy consisted of paclitaxel in 11 patients and cisplatin in 1. The median number of cycles of chemotherapy was 5.
  
  
  RESULTS
  The latent period to PALN recurrence from the time of initial treatment for all patients ranged from 2 to 92 months (median: 12 months). One month after treatment, the clinical tumor response evaluated was complete in 33% (4/12) and partial in 67% (8/12). The 3-year overall survival rate and median survival were 19% and 21 months, respectively. The latent period to PALN recurrence was the only significant prognostic factor; the median survival of patients who relapsed in < or =24 months from the initial treatment of cervical carcinoma was 13 months vs. 45 months for those relapsed at >24 months (p = 0.026). Grade 3-4 hematologic toxicity developed in 2 patients. Six (50%) patients experienced Grade 2 nausea. There were no late gastrointestinal or neurologic complications during the follow-up period. Subsequent distant metastases after PALN treatment developed in 58% (7/12).
  
  
  CONCLUSIONS
  HFRT of 60 Gy to PALN with concurrent chemotherapy could be regarded as an effective treatment modality without significant acute or late toxicity. Patients with a latent period >24 months until PALN recurrence had a more favorable survival rate than those with a latent period </=24 months. Subsequent distant metastasis after PALN recurrence was the main cause of death and is a problem to overcome in the future.
authors.affiliation: Department of Therapeutic Radiology, Chungnam National University, Daejon, South Korea. dkjsk@cnu.ac.kr
authors.forename: Jun-Sang
authors.initials: JS
authors.lastname: Kim
authors.forename: Jae-Sung
authors.initials: JS
authors.lastname: Kim
authors.forename: Sam-Yong
authors.initials: SY
authors.lastname: Kim
authors.forename: K i-Hwan
authors.initials: Ki
authors.lastname: Kim
authors.forename: Moon-June
authors.initials: MJ
authors.lastname: Cho
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D000972:Antineoplastic Agents, Phytogenic / Q000009:adverse effects / Q000627:therapeutic use; D001918:Brachytherapy / Q000009:adverse effects; D018196:Carcinoma, Adenosquamous / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy / Q000556:secondary; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy / Q000556:secondary* / Q000601:surgery; D002945:Cisplatin / Q000009:adverse effects / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D019583:Dose Fractionation, Radiation; D005260:Female; D005500:Follow-Up Studies; D006402:Hematologic Diseases / Q000209:etiology; D006801:Humans; D007044:Hysterectomy; D015993:Life Tables; D015182:Lymphatic Irradiation / Q000009:adverse effects; D008207:Lymphatic Metastasis / Q000532:radiotherapy*; D008875:Middle Aged; D009325:Nausea / Q000209:etiology; D009362:Neoplasm Metastasis; D017239:Paclitaxel / Q000009:adverse effects / Q000627:therapeutic use*; D011832:Radiation Injuries / Q000209:etiology; D018714:Radiotherapy, Adjuvant; D011882:Radiotherapy, High-Energy / Q000009:adverse effects; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery
chemical_list: D000970:Antineoplastic Agents; D000972:Antineoplastic Agents, Phytogenic; D017239:Paclitaxel; D002945:Cisplatin