title: Radiation Therapy for Para-Aortic Lymph Node Metastasis from Uterine Cervical Cancer.
abstract: OBJECTIVE
  To evaluate the efficacy of radiation therapy for para-aortic lymph node metastases from uterine cervical cancer and to identify an optimal radiation regimen.
  
  
  METHODS
  A total of 80 metastatic para-aortic lymph nodes, ranging from 11-50 mm (median=20 mm) on computed tomography, in 22 patients with squamous cell carcinoma of the uterine cervix were initially treated with radiation therapy. Total radiation doses for para-aortic lymph node metastases were 40-61.2 Gy (median=50.4 Gy) in 1.8-2 Gy fractions.
  
  
  RESULTS
  Eight out of the 22 patients remained alive at a median follow-up of 32 months. Seven irradiated lymph nodes, 20-50 mm in diameter, in four patients progressed after irradiation at total doses of 44-50.4 Gy. No metastatic lymph nodes administered >50.4 Gy (median=55.8 Gy) exhibited progression after irradiation. All metastatic lymph nodes ≤ 25 mm in diameter irradiated with 50 or 50.4 Gy were controlled. The 3-year lymph node progression-free rates were 78% in the cohort of 22 patients and 89% considering all 80 metastatic lymph nodes. Apart from transient hematological reactions, two patients developed grade 3 or more therapy-related toxicities, including radiation proctitis in one and hemorrhagic cystitis and colitis in another.
  
  
  CONCLUSIONS
  Radiation therapy can effectively control para-aortic lymph node metastases in patients with uterine cervical cancer. A total dose of 50.4 Gy in 1.8 Gy fractions is sufficient to control metastatic lymph nodes ≤ 25 mm in diameter, whereas a higher dose (approximately 55.8 Gy) may be required for larger nodes.
authors.affiliation: Division of Radiation Oncology, Department of Oncology, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan Department of Radiology, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan mhata@syd.odn.ne.jp.
authors.forename: Masaharu
authors.initials: M
authors.lastname: Hata
authors.affiliation: Division of Gynecologic Oncology, Department of Oncology, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan Department of Obstetrics and Gynecology, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan.
authors.forename: Etsuko
authors.initials: E
authors.lastname: Miyagi
authors.affiliation: Department of Radiology, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan.
authors.forename: Izumi
authors.initials: I
authors.lastname: Koike
authors.affiliation: Department of Obstetrics and Gynecology, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan.
authors.forename: Reiko
authors.initials: R
authors.lastname: Numazaki
authors.affiliation: Department of Obstetrics and Gynecology, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan.
authors.forename: Mikiko
authors.initials: M
authors.lastname: Asai-Sato
authors.affiliation: Department of Radiology, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan.
authors.forename: Takeo
authors.initials: T
authors.lastname: Kasuya
authors.affiliation: Department of Radiology, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan.
authors.forename: Hisashi
authors.initials: H
authors.lastname: Kaizu
authors.affiliation: Department of Radiology, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan.
authors.forename: Yuki
authors.initials: Y
authors.lastname: Mukai
authors.affiliation: Department of Obstetrics and Gynecology, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan.
authors.forename: Fumiki
authors.initials: F
authors.lastname: Hirahara
authors.affiliation: Department of Radiology, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan.
authors.forename: Tomio
authors.initials: T
authors.lastname: Inoue
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001011:Aorta / Q000473:pathology*; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology; D008207:Lymphatic Metastasis / Q000532:radiotherapy*; D008875:Middle Aged; D016019:Survival Analysis; D002583:Uterine Cervical Neoplasms / Q000532:radiotherapy*
keywords: Cervical cancer; para-aortic lymph node metastasis; radiation therapy; squamous cell carcinoma; uterine cervix