title: Intraoperative electron-beam radiation therapy with or without external-beam radiotherapy in the management of paraaortic lymph-node oligometastases from gynecological malignancies.
abstract: OBJECTIVE
  To analyze long-term outcomes and prognostic factors in patients with paraaortic lymph-node oligometastases (LNO) from gynecological malignancies treated in a multimodal protocol.
  
  
  METHODS
  Patients with a histological diagnosis of LNO gynecological cancer [uterine cervix (n = 14, 40 %), endometrial (n = 18, 51 %), ovarian (n = 3, 9 %)] who underwent surgery with radical intent and intraoperative radiotherapy (IORT), median dose 12.5 Gy) were considered eligible for participation in this study. Additionally, 51 % received external-beam radiotherapy (EBRT).
  
  
  RESULTS
  From 1997 to 2012, a total of 35 patients from a single institution were analyzed. With a median follow-up time of 55 months (range 2-148), 5-year loco-regional control (LRC), disease-free survival (DFS) and overall survival (OS) were 79, 44 and 49 %, respectively. On multivariate analysis, no EBRT treatment to the LNO (p = 0.03), and time interval from primary tumor diagnosis to LNO <24 months (p = 0.04) remained significantly associated with locoregional recurrence (LRR). We found on multivariate analysis that only R1 margin status (p = 0.01) was significantly associated with OS.
  
  
  CONCLUSIONS
  From the current series of patients with gynecological LNO, it emerges the fact that EBRT promotes local control. Future prospective studies might be designed according to the predicted risk of LRR focusing on different subgroups.
authors.affiliation: Service of Radiation Oncology, Instituto de Radiomedicina, Santiago, Chile. cvsole@uc.cl.|Health Research Institute of Hospital Gregorio Marañón, Madrid, Spain. cvsole@uc.cl.
authors.forename: C V
authors.initials: CV
authors.lastname: Sole
authors.affiliation: Health Research Institute of Hospital Gregorio Marañón, Madrid, Spain.|Department of Oncology, Hospital General Universitario Gregorio Marañón, C/Doctor Esquerdo 46, 28007, Madrid, Spain.|School of Medicine, Complutense University, Madrid, Spain.
authors.forename: F A
authors.initials: FA
authors.lastname: Calvo
authors.affiliation: Health Research Institute of Hospital Gregorio Marañón, Madrid, Spain.|School of Medicine, Complutense University, Madrid, Spain.
authors.forename: S
authors.initials: S
authors.lastname: Lizarraga
authors.affiliation: Health Research Institute of Hospital Gregorio Marañón, Madrid, Spain.|School of Medicine, Complutense University, Madrid, Spain.|Service of General Surgery III, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: L
authors.initials: L
authors.lastname: Gonzalez-Bayon
authors.affiliation: Health Research Institute of Hospital Gregorio Marañón, Madrid, Spain.|School of Medicine, Complutense University, Madrid, Spain.|Service of General Surgery III, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: J L
authors.initials: JL
authors.lastname: García-Sabrido
mesh_terms: D000328:Adult; D000368:Aged; D017024:Chemotherapy, Adjuvant; D018572:Disease-Free Survival; D005260:Female; D005833:Genital Neoplasms, Female / Q000532:radiotherapy*; D006801:Humans; D007432:Intraoperative Period; D008207:Lymphatic Metastasis / Q000532:radiotherapy*; D008875:Middle Aged; D016016:Proportional Hazards Models; D011878:Radiotherapy / Q000379:methods*; D018714:Radiotherapy, Adjuvant
keywords: External-beam radiotherapy; Long-term outcomes; Lymph-node oligometastases