title: Is extended-field concurrent chemoradiation an option for radiologic negative paraaortic lymph node, locally advanced cervical cancer?
abstract: BACKGROUND
  The aim was to evaluate whether extended-field concurrent chemoradiation (EF-CCRT) leads to results better than those obtained by standard whole-pelvis concurrent chemoradiation (WP-CCRT) in locally advanced cervical cancer with radiologic negative paraaortic lymph nodes (PALNs).
  
  
  METHODS
  A total of 102 patients with histopathologically proven squamous cell carcinoma, adenocarcinoma, or adenosquamous cell carcinoma, and radiologic negative PALN locally advanced cervical cancer, stage IIB-IVA, were accrued between July 2007 and April 2008 and were randomly assigned to WP-CCRT (50 patients) or EF-CCRT (52 patients), followed by high-dose rate brachytherapy. Data regarding the safety profile, response rates, and occurrence of local, PALN, or distant failure were recorded.
  
  
  RESULTS
  During a median follow-up time of 60 months (18-66), 74/102 patients completed the treatment protocol and were analyzed. Overall PALN, distant-metastasis control, disease-free survival, and overall survival rates were 97.1%, 86.9%, 80.3%, and 72.4% in EF-CCRT respectively in comparison with WP-CCRT (82.1%,74.7%, 69.1%, and 60.4%), with P-values of 0.02, 0.03, 0.03 and 0.04 respectively. No difference in acute toxicity profile was seen between the groups, and late toxicities were mild and minimal.
  
  
  CONCLUSIONS
  Prophylactic EF-CCRT can be a reasonable option in patients with locally advanced cervical cancer with radiologic positive pelvic lymph nodes and radiologic negative PALN.
authors.affiliation: Radiation Oncology, Comprehensive Cancer Center, King Fahad Medical City, Riyadh, Saudi Arabia.
authors.forename: Mushabbab Al
authors.initials: MA
authors.lastname: Asiri
authors.affiliation: Radiation Oncology, Comprehensive Cancer Center, King Fahad Medical City, Riyadh, Saudi Arabia.
authors.forename: Mutahir A
authors.initials: MA
authors.lastname: Tunio
authors.affiliation: Radiation Oncology, National Cancer Institute, Cairo University, Cairo, Egypt.
authors.forename: Reham
authors.initials: R
authors.lastname: Mohamed
authors.affiliation: Radiation Oncology, National Cancer Institute, Cairo University, Cairo, Egypt.
authors.forename: Yasser
authors.initials: Y
authors.lastname: Bayoumi
authors.affiliation: Radiation Oncology, Comprehensive Cancer Center, King Fahad Medical City, Riyadh, Saudi Arabia.
authors.forename: Abdulrehman
authors.initials: A
authors.lastname: Alhadab
authors.affiliation: Medical Oncology, Comprehensive Cancer Center, King Fahad Medical City, Riyadh, Saudi Arabia.
authors.forename: Rasha M
authors.initials: RM
authors.lastname: Saleh
authors.affiliation: Radiation Oncology, Comprehensive Cancer Center, King Fahad Medical City, Riyadh, Saudi Arabia.
authors.forename: Muhannad Saud
authors.initials: MS
authors.lastname: AlArifi
authors.affiliation: Women's Specialized Hospital, King Fahad Medical City, Riyadh, Saudi Arabia.
authors.forename: Abdelaziz
authors.initials: A
authors.lastname: Alobaid
keywords: concurrent chemotherapy; prophylactic extended field radiation therapy