title: Definitive extended-field intensity-modulated radiotherapy with chemotherapy for cervical cancer with para-aortic nodal metastasis.
abstract: OBJECTIVE
  To evaluate the efficacy and toxicity of definitive extended-field intensity-modulated radiotherapy (EF-IMRT) with chemotherapy in cervical cancer with para-aortic lymph node (PAN) metastasis.
  
  
  METHODS
  The present retrospective cohort study involved 45 consecutive patients. EF-IMRT consisted of 46 Gy to pelvic and para-aortic regions, 14 Gy-boost to gross nodes, and 30 Gy in six fractions of intracavitary brachytherapy. Platinum-based chemotherapy occurred simultaneously.
  
  
  RESULTS
  Two-year overall and disease-free survival rates (median follow-up=30 months) were 85.4% and 61.7%, respectively. In 78%, 89%, and 89%, the primary cervical mass, pelvic metastasis, and PAN metastasis exhibited a complete response, respectively. Ten, four, and other four patients exhibited locoregional (including post-treatment residual disease), distant, and combined failure, respectively. The most common severe acute toxicity was hematological (n=36). One and two patients had severe late gastrointestinal and other toxicities, respectively.
  
  
  CONCLUSIONS
  EF-IMRT (to 60 Gy) plus chemotherapy resulted in good locoregional control, survival rates, and acceptable toxicity.
authors: Departments of Radiation Oncology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, South Korea Department of Radiation Oncology, Kyung Hee University Medical Center, Kyung Hee University School of Medicine, Seoul, South Korea.
authors: Jinhong
authors: J
authors: Jung
authors: Departments of Radiation Oncology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, South Korea.
authors: Geumju
authors: G
authors: Park
authors: Departments of Radiation Oncology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, South Korea ysk@amc.seoul.kr.
authors: Young Seok
authors: YS
authors: Kim
mesh_terms: D000328:Adult; D000368:Aged; D059248:Chemoradiotherapy; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D049268:Positron-Emission Tomography; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D002583:Uterine Cervical Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*
keywords: Uterine cervical cancer; chemotherapy; extended-field radiotherapy; intensity-modulated radiotherapy