title: Radiation therapy with or without chemotherapy for cervical cancer with periaortic lymph node metastasis.
abstract: The purpose of this article is to evaluate the efficacy of chemoradiation therapy (CRT) and radiation therapy (RT) alone for cervical cancer with periaortic nodal metastasis (PANM). Twenty-one patients with cervical cancer with PANM were identified. Eleven patients received concomitant CRT with cisplatin-based chemotherapy and 10 received RT alone. The median age was 44 years. Ten, 5, and 6 patients had International Federation of Gynecology and Obstetrics stages IB, IIB, and IIIB disease. The RT doses to point A and the periaortic region were 80 to 85 Gy (low dose rate equivalent) and 45 Gy. The median follow-up was 26 months (range 3 to 141 months). The 1- and 3-year disease-specific survival were 81.8% and 81.8%, and 70% and 30%, respectively, for the CRT and RT groups, (P = 0.11). The 1- and 3-year pelvic and periaortic control rates (PPC) were 100% and 100% (CRT), and 56.3% and 42.2% (RT) (P = 0.03). The 1- and 3-year free-from-distant metastasis (DM) rates were 81.8% and 81.8% (CRT), and 78.7% and 49.2% (RT) (P = 0.54). All patients who developed DM died of their disease. CRT is a feasible treatment option to improve the PPC for these patients. Because of the high rate of distant metastasis despite PPC, more effective systemic therapy should be explored.
authors.affiliation: Gershenson Radiation Oncology Center, Barbara Ann Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI, USA.
authors.forename: Ayman
authors.initials: A
authors.lastname: Saad
authors.forename: Simon S
authors.initials: SS
authors.lastname: Lo
authors.forename: Ihn
authors.initials: I
authors.lastname: Han
authors.forename: Sameer
authors.initials: S
authors.lastname: Keole
authors.forename: Charles P
authors.initials: CP
authors.lastname: Lee
authors.forename: Sam
authors.initials: S
authors.lastname: Tekyi-Mensah
authors.forename: Adnan
authors.initials: A
authors.lastname: Munkarah
authors.forename: John
authors.initials: J
authors.lastname: Malone
authors.forename: Robert
authors.initials: R
authors.lastname: Morris
authors.forename: Gunter
authors.initials: G
authors.lastname: Deppe
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy / Q000532:radiotherapy / Q000556:secondary; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001918:Brachytherapy; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy / Q000532:radiotherapy / Q000556:secondary; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008875:Middle Aged; D011379:Prognosis; D011879:Radiotherapy Dosage; D016019:Survival Analysis; D017211:Treatment Failure; D002583:Uterine Cervical Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy*