title: Radiation therapy for pelvic lymph node metastasis from uterine cervical cancer.
abstract: OBJECTIVE
  This study aimed to evaluate the efficacy of radiation therapy for pelvic lymph node metastasis from uterine cervical cancer and identify an optimal radiation regimen.
  
  
  METHODS
  A total of 111 metastatic pelvic lymph nodes, ranging from 11 to 56 mm (median, 25 mm) on CT/MRI, in 62 patients with uterine cervical cancer were treated initially with curative radiation therapy, with 46 patients receiving concurrent chemotherapy. Total radiation doses ranged from 45 to 61.2 Gy (median, 50.4 Gy) in 1.8-2 Gy (median, 1.8 Gy) fractions.
  
  
  RESULTS
  At a median follow-up of 33 months, 46 of the 62 patients survived. Only 2 irradiated lymph nodes, 24 and 28 mm in diameter, in 1 patient progressed after irradiation alone with 50.4 Gy in 1.8 Gy fractions. All 33 metastatic lymph nodes ≥ 30 mm in diameter were controlled by irradiation at a median dose of 55.8 Gy. The 3-year lymph node-progression free rates were 98.2% in all 62 patients and 98.0% in all 111 metastatic lymph nodes. Except for transient hematologic reactions, 2 patients developed grade ≥ 3 therapy-related toxicities, 1 with an ulcer and the other with perforation of the sigmoid colon. In addition, 2 patients experienced ileus after irradiation.
  
  
  CONCLUSIONS
  Radiation therapy effectively controlled pelvic lymph node metastases in patients with uterine cervical cancer, with most nodes <24 mm in diameter controlled by total doses of 50.4 Gy in 1.8 Gy fractions and larger nodes controlled by 55.8 Gy, particularly with concurrent chemotherapy. Higher doses to metastatic lymph nodes may increase intestinal toxicities.
authors.affiliation: Department of Radiology, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan. Electronic address: mhata@syd.odn.ne.jp.
authors.forename: Masaharu
authors.initials: M
authors.lastname: Hata
authors.forename: Izumi
authors.initials: I
authors.lastname: Koike
authors.forename: Etsuko
authors.initials: E
authors.lastname: Miyagi
authors.forename: Reiko
authors.initials: R
authors.lastname: Numazaki
authors.forename: Mikiko
authors.initials: M
authors.lastname: Asai-Sato
authors.forename: Takeo
authors.initials: T
authors.lastname: Kasuya
authors.forename: Hisashi
authors.initials: H
authors.lastname: Kaizu
authors.forename: Tonika
authors.initials: T
authors.lastname: Matsui
authors.forename: Fumiki
authors.initials: F
authors.lastname: Hirahara
authors.forename: Tomio
authors.initials: T
authors.lastname: Inoue
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000209:etiology; D002277:Carcinoma / Q000188:drug therapy / Q000532:radiotherapy* / Q000556:secondary*; D059248:Chemoradiotherapy; D018450:Disease Progression; D018572:Disease-Free Survival; D019583:Dose Fractionation, Radiation; D005260:Female; D006801:Humans; D007410:Intestinal Diseases / Q000209:etiology; D007970:Leukopenia / Q000209:etiology; D008207:Lymphatic Metastasis; D008875:Middle Aged; D010388:Pelvis; D011878:Radiotherapy / Q000009:adverse effects; D015996:Survival Rate; D013921:Thrombocytopenia / Q000209:etiology; D002583:Uterine Cervical Neoplasms / Q000473:pathology* / Q000532:radiotherapy*; D055815:Young Adult
keywords: Cervical cancer; Pelvic lymph node metastasis; Radiation therapy; Uterine cervix