title: Risk stratification for failure in patients with advanced cervical cancer after concurrent chemoradiotherapy: another way to optimise treatment results.
abstract: OBJECTIVE
  To identify risk factors for disease-free survival (DFS) and para-aortic lymph node (PALN) metastasis in advanced cervical cancer patients after concurrent chemoradiotherapy (CCRT) using risk stratification.
  
  
  METHODS
  In total, 148 patients with stage IB2-IVA cervical cancer without PALN metastasis treated with a full course of CCRT were included for analysis. Radiotherapy consisted of external beam irradiation followed by four courses of high-dose rate intracavitary brachytherapy using 6.0 Gy to point A. Chemotherapy consisted of weekly cisplatin at a dose of 40mg/m(2) for a planned six cycles. Cox's proportional hazards model was used for risk stratification for DFS and PALN relapse-free survival.
  
  
  RESULTS
  Patients were divided into low- and high-risk groups. The low-risk group was composed of patients with stage IB-IIB disease without enlarged pelvic nodes, whereas the high-risk group was comprised of patients with stage IB2-IIB tumours with enlarged nodes or those with stage III-IVA disease. The 4-year DFS for the low- and high-risk groups was 83 and 52%, respectively (P=0.0001, relative risk 4.51, 95% confidence interval 1.3-10.7), whereas the 4-year PALN metastasis-free survival for the low- and high-risk groups was 92 and 61%, respectively (P=0.0003, relative risk 4.93, 95% confidence interval 1.2-12.5).
  
  
  CONCLUSIONS
  The risk of failure in advanced cervical cancer patients treated in the CCRT era can be predicted. For patients with high risk of PALN relapse, this study can provide patient selection criteria when considering prophylactic PALN irradiation.
authors.affiliation: Department of Radiation Therapy and Oncology, China Medical University Hospital, Taiwan.
authors.forename: Ji-An
authors.initials: JA
authors.lastname: Liang
authors.forename: Shang-Wen
authors.initials: SW
authors.lastname: Chen
authors.forename: Wei-Chun
authors.initials: WC
authors.lastname: Chang
authors.forename: Yao-Ching
authors.initials: YC
authors.lastname: Hung
authors.forename: Lian-Shung
authors.initials: LS
authors.lastname: Yeh
authors.forename: Shih-Neng
authors.initials: SN
authors.lastname: Yang
authors.forename: Fang-Jen
authors.initials: FJ
authors.lastname: Lin
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy / Q000473:pathology* / Q000532:radiotherapy*; D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001918:Brachytherapy / Q000379:methods*; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy / Q000473:pathology* / Q000532:radiotherapy*; D002945:Cisplatin / Q000627:therapeutic use; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008207:Lymphatic Metastasis; D008875:Middle Aged; D049268:Positron-Emission Tomography; D016016:Proportional Hazards Models; D012307:Risk Factors; D002583:Uterine Cervical Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000532:radiotherapy*
chemical_list: D000970:Antineoplastic Agents; D002945:Cisplatin