title: Optimal Extent of Prophylactic Irradiation of Paraaortic Lymph Nodes in Patients with Uterine Cervical Cancer.
abstract: OBJECTIVE
  The purpose of this study was to determine optimal extent of prophylactic irradiation of paraaortic lymph nodes (PALN) in patients with uterine cervical cancer who had metastatic pelvic LNs.
  
  
  METHODS
  We retrospectively evaluated 103 patients with cervical cancer and pelvic lymph node metastasis who were treated with prophylactic semi-extended field radiotherapy (SEFRT) between 1990 and 2012. The semi-extended field included PALN below the second lumbar spine with prescribed doses of 45 to 50 Gy. Survival outcomes were calculated using the Kaplan-Meier method, and acute and late toxicities were scored using the Radiation Therapy Oncology Group and European Organisation for Research and Treatment of Cancer toxicity criteria.
  
  
  RESULTS
  The median follow-up after SEFRT was 61 (range 5-296) months. Overall, 28 patients (27.2%) experienced treatment failures, which were classified as local in 8 patients (7.8%), regional in 8 patients (7.8%), and distant in 13 patients (12.6%). Of the regional failures, only two involved PALN failure around the renal artery or the renal hilum area at the upper margin of the semi-extended field. At 5 years, the overall survival was 82%. Grade 3 or higher acute gastrointestinal and genitourinary toxicities occurred in one and two patients, respectively. As a late toxicity, one patient developed grade 3 small bowel obstruction.
  
  
  CONCLUSIONS
  Prophylactic SEFRT provided favorable outcomes with little acute or late gastrointestinal toxicity. For prophylaxis of PALN recurrences, upper part of PALN might not need to be included in patients with uterine cervical cancer and metastatic pelvic LNs.
authors.affiliation: Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University, College of Medicine, Seoul, Korea.
authors.forename: Jinhyun
authors.initials: J
authors.lastname: Choi
authors.affiliation: Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University, College of Medicine, Seoul, Korea.|Department of Pharmacology, Brain Korea 21 plus Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Hong In
authors.initials: HI
authors.lastname: Yoon
authors.affiliation: Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University, College of Medicine, Seoul, Korea.
authors.forename: Jeongshim
authors.initials: J
authors.lastname: Lee
authors.affiliation: Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University, College of Medicine, Seoul, Korea.
authors.forename: Ki Chang
authors.initials: KC
authors.lastname: Keum
authors.affiliation: Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University, College of Medicine, Seoul, Korea.|Department of Radiation Oncology, Jeju National University School of Medicine, Jeju, Korea.
authors.forename: Gwi Eon
authors.initials: GE
authors.lastname: Kim
authors.affiliation: Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University, College of Medicine, Seoul, Korea.|Yonsei Song-Dang Institute for Cancer Research, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Yong Bae
authors.initials: YB
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D005720:Gamma Rays / Q000009:adverse effects / Q000627:therapeutic use*; D005767:Gastrointestinal Diseases / Q000209:etiology; D006801:Humans; D053208:Kaplan-Meier Estimate; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis / Q000473:pathology; D008875:Middle Aged; D009367:Neoplasm Staging; D010386:Pelvic Neoplasms / Q000401:mortality / Q000532:radiotherapy* / Q000556:secondary; D049268:Positron-Emission Tomography; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000150:complications / Q000401:mortality / Q000473:pathology*