title: Impact of paraaortic lymphadenectomy for endometrial cancer with positive pelvic lymph nodes: A Korean Radiation Oncology Group study (KROG 13-17).
abstract: OBJECTIVE
  We investigated the role of paraaortic lymph node dissection (PALND) in patients with stage IIIC1 endometrial carcinoma after surgery followed by adjuvant radiotherapy (RT) alone or chemoradiotherapy (CTRT).
  
  
  METHODS
  We performed a subgroup analysis in 151 patients treated with adjuvant pelvic RT. Paraaortic-recurrence free survival, disease-free survival (DFS) and overall survival (OS) were analyzed.
  
  
  RESULTS
  In adjuvant RT alone, PALND was significantly related to reduced risk of paraaortic recurrence (0% vs. 17.1%) and distant metastasis (4.5% vs. 19.5%) compared with the no PALND group. PALND affected 5-year DFS (90.2% vs. 58.9%, p = 0.016) and OS (100% vs. 83.1%, p = 0.022). For the CTRT group, the paraaortic recurrence rate was 19.5% for the no PALND group and 12.8% for the PALND group (p = 0.682). Of patients who underwent PALND in the CTRT group, less extensive PALND was significantly related to increased paraaortic recurrence (≤10 vs. >10 dissected LNs, 17.1% vs. 0%). In the no PALND group (n = 82), 5-year paraaortic-recurrence free survival was 79.4% for the CTRT group and 76.2% for the RT alone group (p = 0.941). In multivariate analysis, PALND was significantly associated with reduced risk of disease-specific death (HR, 0.50; 95% CI, 0.26-0.96; p = 0.037).
  
  
  CONCLUSIONS
  PALND provided excellent paraaortic control and improved outcome in stage IIIC1 endometrial cancer with favorable tumor features treated with adjuvant RT alone. Less extensive PALND was associated with significantly increased paraaortic recurrence in patients with advanced tumor features treated with adjuvant CTRT. Combined CTRT did not affect disease control in the paraaortic region compared with RT alone.
authors.affiliation: Department of Radiation Oncology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Jeollanam-do, Republic of Korea.
authors.forename: M S
authors.initials: MS
authors.lastname: Yoon
authors.affiliation: Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea. Electronic address: wonro.park@samsung.com.
authors.forename: W
authors.initials: W
authors.lastname: Park
authors.affiliation: Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors.forename: S J
authors.initials: SJ
authors.lastname: Huh
authors.affiliation: Department of Radiation Oncology, Seoul National University Hospital, Seoul, Republic of Korea.
authors.forename: H J
authors.initials: HJ
authors.lastname: Kim
authors.affiliation: Department of Radiation Oncology, Asan Medical Center, Seoul, Republic of Korea.
authors.forename: Y S
authors.initials: YS
authors.lastname: Kim
authors.affiliation: Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Y B
authors.initials: YB
authors.lastname: Kim
authors.affiliation: Center for Uterine Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea.
authors.forename: J-Y
authors.initials: JY
authors.lastname: Kim
authors.affiliation: Department of Radiation Oncology, St. Vincent's Hospital, The Catholic University of Korea, College of Medicine, Suwon, Republic of Korea.
authors.forename: J-H
authors.initials: JH
authors.lastname: Lee
authors.affiliation: Department of Radiation Oncology, Inha University School of Medicine, Incheon, Republic of Korea.
authors.forename: H J
authors.initials: HJ
authors.lastname: Kim
authors.affiliation: Department of Radiation Oncology, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea.
authors.forename: J
authors.initials: J
authors.lastname: Cha
authors.affiliation: Department of Radiation Oncology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Republic of Korea.
authors.forename: J H
authors.initials: JH
authors.lastname: Kim
authors.affiliation: Department of Radiation Oncology, Cheil General Hospital and Women's Healthcare Center, Kwandong University, College of Medicine, Seoul, Republic of Korea.
authors.forename: J
authors.initials: J
authors.lastname: Kim
authors.affiliation: Department of Radiation Oncology, Korea University College of Medicine, Seoul, Republic of Korea.
authors.forename: W S
authors.initials: WS
authors.lastname: Yoon
authors.affiliation: Department of Radiation Oncology, Chung-Ang University Hospital, Seoul, Republic of Korea.
authors.forename: J H
authors.initials: JH
authors.lastname: Choi
authors.affiliation: Department of Radiation Oncology, Ajou University School of Medicine, Suwon, Republic of Korea.
authors.forename: M
authors.initials: M
authors.lastname: Chun
authors.affiliation: Department of Radiation Oncology, Dong-A University School of Medicine, Busan, Republic of Korea.
authors.forename: Y
authors.initials: Y
authors.lastname: Choi
authors.affiliation: Department of Radiation Oncology, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea.
authors.forename: S K
authors.initials: SK
authors.lastname: Chang
authors.affiliation: Department of Radiation Oncology, University of Wonkwang School of Medicine, Iksan, Republic of Korea.
authors.forename: K K
authors.initials: KK
authors.lastname: Lee
authors.affiliation: Department of Radiation Oncology, Incheon St. Marys Hospital, The Catholic University of Korea, Incheon, Republic of Korea.
authors.forename: M
authors.initials: M
authors.lastname: Kim
authors.affiliation: Department of Radiation Oncology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Jeollanam-do, Republic of Korea.
authors.forename: J-U
authors.initials: JU
authors.lastname: Jeong
authors.affiliation: Department of Radiation Oncology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Jeollanam-do, Republic of Korea. Electronic address: tknam@chonnam.ac.kr.
authors.forename: T-K
authors.initials: TK
authors.lastname: Nam
mesh_terms: D000328:Adult; D000368:Aged; D059248:Chemoradiotherapy; D016889:Endometrial Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008875:Middle Aged; D010388:Pelvis / Q000473:pathology; D018714:Radiotherapy, Adjuvant
keywords: Endometrial cancer; Extended-field RT; Lymphadenectomy; Paraaortic recurrence