title: Treatment outcomes of extended-field radiation therapy and the effect of concurrent chemotherapy on uterine cervical cancer with para-aortic lymph node metastasis.
abstract: OBJECTIVE
  To review the clinical outcomes of extended-field radiation therapy (EFRT) and to analyze prognostic factors significant for survival in patients receiving EFRT for uterine cervical carcinoma with para-aortic node (PAN) metastasis.
  
  
  METHODS
  We retrospectively reviewed 90 patients with stage IB-IVA cervical cancer and PAN metastasis between 1987 and 2012. Median age was 50 (range, 24-77). Patients received median 70.2 Gy (range, 56-93) to point A and median 50.4 Gy (range, 45-60.4) to PAN over median 69 elapsed days (range, 43-182). Forty-six patients (51.1%) received concurrent chemotherapy. Survival was calculated using the Kaplan-Meier method. We analyzed prognostic factors for overall actuarial survival (OS) and progression-free survival (PFS) using a Cox regression method.
  
  
  RESULTS
  The median follow-up period for surviving patients was 55 months (range, 3-252). Seventy patients (77.8%) had complete remission. Forty-six patients experienced treatment failure as follows: 11 patients (12.2%) as local recurrence, 19 (21%) as regional recurrence and 33 (36.7%) as distant metastasis. The 5-yr OS and PFS were 62.6% and 43.9%, respectively. Treatment response was the only statistically independent prognostic factors for OS (p= 0.04) and PFS (p< 0.001) on multivariate analysis. Grade 3 or 4 hematologic gastrointestinal and urogenital toxicities were observed in about 10% of patients.
  
  
  CONCLUSIONS
  Our institutional experiences showed that EFRT was an effective treatment for cervical cancer patients with PAN metastasis. The addition of chemotherapy to EFRT seems to have uncertain survival benefit with higher hematologic toxicity.
authors.affiliation: Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Korea. yhi0225@yuhs.ac.|Department of Pharmacology, Brain Korea 21 plus Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea. yhi0225@yuhs.ac.
authors.forename: Hong In
authors.initials: HI
authors.lastname: Yoon
authors.affiliation: Department of Radiation Oncology, Yonsei University Wonju College of Medicine, Wonju, Korea. lukanus@yonsei.ac.kr.
authors.forename: Jihye
authors.initials: J
authors.lastname: Cha
authors.affiliation: Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Korea. kckeum@yuhs.ac.|Yonsei Song-Dang Institute for Cancer Research, Yonsei University College of Medicine, Seoul, Korea. kckeum@yuhs.ac.
authors.forename: Ki Chang
authors.initials: KC
authors.lastname: Keum
authors.affiliation: Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Korea. ha-yoon.y.lee@gsk.com.
authors.forename: Ha Yoon
authors.initials: HY
authors.lastname: Lee
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, Korea. NAHMEJ6@yuhs.ac.
authors.forename: Eun Ji
authors.initials: EJ
authors.lastname: Nam
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, Korea. SAN1@yuhs.ac.
authors.forename: Sang Wun
authors.initials: SW
authors.lastname: Kim
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, Korea. SHKIM70@yuhs.ac.
authors.forename: Sunghoon
authors.initials: S
authors.lastname: Kim
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, Korea. YTKCHOI@yuhs.ac.
authors.forename: Young Tae
authors.initials: YT
authors.lastname: Kim
authors.affiliation: Department of Radiation Oncology, Jeju National University School of Medicine, Jeju, Korea. gekim@yuhs.ac.
authors.forename: Gwi Eon
authors.initials: GE
authors.lastname: Kim
authors.affiliation: Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Korea. ybkim3@yuhs.ac.|Yonsei Song-Dang Institute for Cancer Research, Yonsei University College of Medicine, Seoul, Korea. ybkim3@yuhs.ac.
authors.forename: Yong Bae
authors.initials: YB
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D016190:Carboplatin / Q000008:administration & dosage; D018287:Carcinoma, Large Cell / Q000401:mortality / Q000556:secondary / Q000628:therapy*; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000556:secondary / Q000628:therapy*; D059248:Chemoradiotherapy; D002945:Cisplatin / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009367:Neoplasm Staging; D010220:Para-Aortic Bodies / Q000187:drug effects / Q000473:pathology* / Q000528:radiation effects; D011379:Prognosis; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D015996:Survival Rate; D002583:Uterine Cervical Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D055815:Young Adult
chemical_list: D016190:Carboplatin; D002945:Cisplatin