title: The role of elective para-aortic lymph node irradiation in patients with locally advanced cervical cancer.
abstract: OBJECTIVE
  Pelvic lymph node positivity in cervical cancer is known to be an adverse prognostic factor and is associated with an elevated risk of clinically occult para-aortic lymph node metastases. The purpose of this study was to examine the benefit of elective para-aortic lymph node radiotherapy (PART) in patients with no clinical or radiographic evidence of para-aortic lymph node metastases receiving concurrent cisplatin chemotherapy.
  
  
  METHODS
  Patients treated with radiotherapy and concurrent cisplatin for cervical cancer from 1999 to 2009 were identified in two prospective databases. All patients received external beam pelvic radiotherapy (PRT) to a median dose of 50 Gy concurrently with weekly cisplatin 40 mg/m(2). This was followed by pulse dose rate intracavitary brachytherapy to a median dose of 40 Gy. Patients at high risk of occult para-aortic metastases also received PART to a median dose of 40 Gy.
  
  
  RESULTS
  There were 228 patients suitable for analysis; the median follow-up was 4.6 years. The addition of PART to PRT was not associated with a significant difference in disease-free survival (hazard ratio 1.1, confidence interval 0.7-1.8, P = 0.75) or overall survival (hazard ratio 1.6, confidence interval 0.9-2.7, P = 0.11) on multivariate analysis. There was no significant difference in the rate of para-aortic relapse with PART versus PRT (hazard ratio 2.01, confidence interval 0.79-5.12, P = 0.14). The 3 year grade 3-4 late toxicities were 11% for the PART group versus 8% for PRT (hazard ratio 1.39, confidence interval 0.58-3.37, P = 0.47).
  
  
  CONCLUSIONS
  These results suggest that cervical cancer patients treated with radiotherapy and concurrent cisplatin do not benefit from elective PART.
authors.affiliation: Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Ontario, Canada.
authors.forename: M L
authors.initials: ML
authors.lastname: Yap
authors.affiliation: Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Ontario, Canada.
authors.forename: J
authors.initials: J
authors.lastname: Cuartero
authors.affiliation: Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
authors.forename: J
authors.initials: J
authors.lastname: Yan
authors.affiliation: Division of Biostatistics, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Dalla Lana School of Public Health Sciences, University of Toronto, Toronto, Ontario, Canada.
authors.forename: M
authors.initials: M
authors.lastname: Pintilie
authors.affiliation: Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Ontario, Canada.
authors.forename: A
authors.initials: A
authors.lastname: Fyles
authors.affiliation: Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Ontario, Canada.
authors.forename: W
authors.initials: W
authors.lastname: Levin
authors.affiliation: Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Ontario, Canada.
authors.forename: L
authors.initials: L
authors.lastname: Manchul
authors.affiliation: Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Ontario, Canada. Electronic address: mike.milosevic@rmp.uhn.on.ca.
authors.forename: M
authors.initials: M
authors.lastname: Milosevic
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D059248:Chemoradiotherapy; D002945:Cisplatin / Q000627:therapeutic use*; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology* / Q000528:radiation effects*; D008207:Lymphatic Metastasis; D008875:Middle Aged; D010388:Pelvis / Q000473:pathology; D011446:Prospective Studies; D002583:Uterine Cervical Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy*; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents; D002945:Cisplatin
keywords: Cervical cancer; chemoradiotherapy; para-aortic lymph nodes; radiotherapy