title: Postoperative external beam irradiation with and without brachytherapy in pelvic node-positive IB1-IIA2 cervical cancer patients: a retrospective clinical study.
abstract: BACKGROUND
  This study assessed the survival outcomes and recurrent patterns in pelvic node-positive IB1-IIA2 cervical cancer patients treated with postoperative external beam irradiation with or without vaginal brachytherapy.
  
  
  METHODS
  The records of 1149 cervical cancer patients received radical surgery between February 2008 and March 2010 were retrospectively reviewed. 126 stages IB1-IIA2 patients with positive pelvic lymph node (LN) were included and a total of 113 patients who received different postoperative radiation therapy were identified and analyzed. Of the enrolled patients, 55 patients received pelvic external beam radiotherapy (EBRT) without vaginal brachytherapy and 58 patients received pelvic EBRT with vaginal brachytherapy. Treatment-related toxicities were evaluated. Progression-free survival (PFS) and overall survival (OS) were analyzed using Kaplan-Meier estimates and statistical significance was determined using the log-rank test.
  
  
  RESULTS
  With a median follow-up of 47 months (range: 10-61 months), the group which had pelvic EBRT with brachytherapy had a significantly improved 5-year PFS rate (P = 0.044), but no significant difference in 5-year overall survival was found between the two groups (P = 0.437). In patients treated without brachytherapy, the most common site of relapse was the pelvis. No significant differences were found regards to acute and chronic radiation toxicities, including myelosuppression, dermatitis, enterocolitis, proctitis and cystitis (P = 0.485, 0.875, 0.671, 0.459 and 0.969 respectively) between the groups of pelvic EBRT with and without vaginal brachytherapy.
  
  
  CONCLUSIONS
  Treated with pelvic EBRT in combination with vaginal brachytherapy, cervical cancer patients with positive pelvic lymph node had a reduced risk of locoregional recurrence without increased side effects compared with patients treated with pelvic EBRT without vaginal brachytherapy.
authors.affiliation: Department of Gynecologic Oncology, The Affiliated Tumor Hospital of Zhengzhou University, Zhengzhou, 450008, China. lilei04301596@163.com.
authors.forename: Lei
authors.initials: L
authors.lastname: Li
authors.affiliation: Department of Gynecologic Oncology, The Affiliated Tumor Hospital of Zhengzhou University, Zhengzhou, 450008, China. kouxinxin126@126.com.
authors.forename: XinXin
authors.initials: X
authors.lastname: Kou
authors.affiliation: Department of Gynecologic Oncology, The Affiliated Tumor Hospital of Zhengzhou University, Zhengzhou, 450008, China. bingjie831023@163.com.
authors.forename: XiaoJie
authors.initials: X
authors.lastname: Feng
authors.affiliation: Department of Gynecologic Oncology, The Affiliated Tumor Hospital of Zhengzhou University, Zhengzhou, 450008, China. 792601@qq.com.
authors.forename: MingChuan
authors.initials: M
authors.lastname: Zhang
authors.affiliation: Department of Gynecologic Oncology, The Affiliated Tumor Hospital of Zhengzhou University, Zhengzhou, 450008, China. chao06@sohu.com.
authors.forename: HongTu
authors.initials: H
authors.lastname: Chao
authors.affiliation: Department of Gynecologic Oncology, The Affiliated Tumor Hospital of Zhengzhou University, Zhengzhou, 450008, China. 13608684100@163.com.
authors.forename: LiYing
authors.initials: L
authors.lastname: Wang
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage; D001918:Brachytherapy / Q000009:adverse effects / Q000379:methods*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008207:Lymphatic Metastasis / Q000532:radiotherapy*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D011878:Radiotherapy / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D002583:Uterine Cervical Neoplasms / Q000401:mortality / Q000473:pathology* / Q000532:radiotherapy*
chemical_list: D000970:Antineoplastic Agents