title: Isolated lymph node relapse of epithelial ovarian carcinoma: outcomes and prognostic factors.
abstract: BACKGROUND
  Relapses of epithelial ovarian carcinoma (EOC) have a poor prognosis. Isolated lymph node relapses (ILNR) are considered of relatively good prognosis with intensive therapy.
  
  
  METHODS
  This retrospective study aimed to describe incidence, characteristics, outcomes and prognostic factors of ILNR treated over 15 years.
  
  
  RESULTS
  Twenty-seven patients (4.2%) experienced an ILNR among 640 patients. Median age was 59 years, tumour stages included stage I (n=4), II (n=5), III (n=15) and IV (n=3). After initial optimal treatment, median progression-free survival (PFS) was 26 months. Sites of relapse were retroperitoneum (n=15), left supraclavicular (n=7), mediastinum (n=4), iliac (n=4) and inguinal (n=3). ILNR locations were unique in 63% of patients (n=17) and multiple in 37% (n=10). Treatment modalities were surgery in eight patients (30%), chemotherapy in 15 (55%) and radiotherapy in 5 patients (18%), alone or in combination. Seven patients without tumour-related symptoms (26%) were not treated. Median overall survival (OS) after ILNR was 26 months. Median OS from initial diagnosis was 68 months. 25% of patients had a very long survival (>100 months), independent of their initial staging or PFS. There was no difference in 2-year survival after ILNR between the groups of early relapse (before 24 months) and late relapse (after 24 months). In the seven non-treated patients, median OS was 91 months.
  
  
  CONCLUSIONS
  ILNR is a rare event in EOC. Time to relapse may not have its usual prognostic value. Immediate or delayed therapy should be discussed in case of asymptomatic ILNR.
authors.affiliation: Service d'Oncologie Médicale, Hôpital Saint Antoine, 184 rue du Faubourg Saint Antoine, 75012, Paris, France. blanchard.pierre@gmail.com
authors.forename: Pierre
authors.initials: P
authors.lastname: Blanchard
authors.forename: Anne
authors.initials: A
authors.lastname: Plantade
authors.forename: Cécile
authors.initials: C
authors.lastname: Pagès
authors.forename: Pauline
authors.initials: P
authors.lastname: Afchain
authors.forename: Christophe
authors.initials: C
authors.lastname: Louvet
authors.forename: Christophe
authors.initials: C
authors.lastname: Tournigand
authors.forename: Aimery
authors.initials: A
authors.lastname: de Gramont
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology* / Q000628:therapy*; D010051:Ovarian Neoplasms / Q000473:pathology* / Q000601:surgery / Q000628:therapy*; D011379:Prognosis; D012008:Recurrence; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome