title: Impact of primary para-aortic lymphadenectomy on distant failure in locally advanced cervical cancer patients treated in the era of image-guided adaptive brachytherapy.
abstract: To investigate the impact of a primary para-aortic lymphadenectomy (PAL) in locally advanced cervical cancer patients receiving definitive chemoradiation, we reviewed the clinical records of consecutive patients treated in our Institution and receiving an external beam irradiation followed with an image-guided adaptive brachytherapy for a locally advanced cervical cancer. We examined the impact of performing a primary PAL as part of primary staging for guiding irradiation fields in patients without extra-pelvic PET uptake. The outcome of patients presenting para-aortic lymph node uptake (PALNU) was also examined. 186 patients were identified. Median follow-up was 44.4 months. Patients receiving a primary PAL (PAL group) and those who received upfront pelvic chemoradiation (no-PAL group) did not significantly differ for loco-regional failures. Survival without distant failure (DFFS), including para-aortic relapses, was at 3 years 87 % (95 % CI 84-90 %) in PAL group, 67 % (95 % CI 59-85 %) in the no-PAL group and 44 % (95 % CI 32-66 %) in the PALNU group (p = 0.04 for comparison between PAL and no-PAL groups). In a multivariate model including para-aortic lymphadenectomy, pelvic nodal uptake and high-risk clinical target volume as adjustment variables, a para-aortic lymphadenectomy was significant for DFS (HR = 0.47, 95 % CI 0.26-0.84, p = 0.01). Although confounding factors could account for these retrospective results, a primary PAL with tailored irradiation fields based on para-aortic histological findings seems to be associated with a better control for distant metastases. A randomized trial is testing the benefit of this strategy.
authors.affiliation: Brachytherapy Unit, Gustave Roussy, 114 rue Edouard Vaillant, 94800, Villejuif, France. cyrus.chargari@gustaveroussy.fr.|INSERM1030, Gustave Roussy Cancer Campus, Villejuif, France. cyrus.chargari@gustaveroussy.fr.|Radiotherapy Department, Gustave Roussy, Villejuif, France. cyrus.chargari@gustaveroussy.fr.|Effets biologiques des rayonnements, Institut de Recherche Biomédicale des Armées, Bretigny-sur-Orge, France. cyrus.chargari@gustaveroussy.fr.
authors.forename: Cyrus
authors.initials: C
authors.lastname: Chargari
authors.affiliation: Brachytherapy Unit, Gustave Roussy, 114 rue Edouard Vaillant, 94800, Villejuif, France.|Radiotherapy Department, Gustave Roussy, Villejuif, France.
authors.forename: Renaud
authors.initials: R
authors.lastname: Mazeron
authors.affiliation: Biostatistics and Epidemiology Unit, Gustave Roussy, Villejuif, France.
authors.forename: Ariane
authors.initials: A
authors.lastname: Dunant
authors.affiliation: Department of Surgery, Gustave Roussy, Villejuif, France.
authors.forename: Sébastien
authors.initials: S
authors.lastname: Gouy
authors.affiliation: Brachytherapy Unit, Gustave Roussy, 114 rue Edouard Vaillant, 94800, Villejuif, France.|Radiotherapy Department, Gustave Roussy, Villejuif, France.
authors.forename: Claire
authors.initials: C
authors.lastname: Petit
authors.affiliation: Brachytherapy Unit, Gustave Roussy, 114 rue Edouard Vaillant, 94800, Villejuif, France.|Radiotherapy Department, Gustave Roussy, Villejuif, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Maroun
authors.affiliation: Department of Surgery, Gustave Roussy, Villejuif, France.
authors.forename: Catherine
authors.initials: C
authors.lastname: Uzan
authors.affiliation: Brachytherapy Unit, Gustave Roussy, 114 rue Edouard Vaillant, 94800, Villejuif, France.|Radiotherapy Department, Gustave Roussy, Villejuif, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Annede
authors.affiliation: Department of Surgery, Gustave Roussy, Villejuif, France.
authors.forename: Enrica
authors.initials: E
authors.lastname: Bentivegna
authors.affiliation: Department of Radiology, Gustave Roussy, Villejuif, France.
authors.forename: Corinne
authors.initials: C
authors.lastname: Balleyguier
authors.affiliation: Department of Pathology, Gustave Roussy, Villejuif, France.
authors.forename: Catherine
authors.initials: C
authors.lastname: Genestie
authors.affiliation: Department of Medical Oncology, Gustave Roussy, Villejuif, France.
authors.forename: Patricia
authors.initials: P
authors.lastname: Pautier
authors.affiliation: Department of Medical Oncology, Gustave Roussy, Villejuif, France.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Leary
authors.affiliation: Department of Medical Oncology, Gustave Roussy, Villejuif, France.
authors.forename: Catherine
authors.initials: C
authors.lastname: Lhomme
authors.affiliation: INSERM1030, Gustave Roussy Cancer Campus, Villejuif, France.|Radiotherapy Department, Gustave Roussy, Villejuif, France.|Faculte de Médecine, University Paris-Sud, SIRIC SOCRATES, Le Kremlin-Bicetre, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Deutsch
authors.affiliation: Department of Surgery, Gustave Roussy, Villejuif, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Morice
authors.affiliation: Brachytherapy Unit, Gustave Roussy, 114 rue Edouard Vaillant, 94800, Villejuif, France.|Radiotherapy Department, Gustave Roussy, Villejuif, France.
authors.forename: Christine
authors.initials: C
authors.lastname: Haie-Meder
mesh_terms: D000328:Adult; D000368:Aged; D001918:Brachytherapy / Q000009:adverse effects; D059248:Chemoradiotherapy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008197:Lymph Node Excision / Q000009:adverse effects*; D008198:Lymph Nodes / Q000473:pathology / Q000601:surgery; D008207:Lymphatic Metastasis / Q000503:physiopathology*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D009367:Neoplasm Staging; D025321:Surgery, Computer-Assisted / Q000009:adverse effects; D002583:Uterine Cervical Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*
keywords: Brachytherapy; Cervical cancer patients; Chemoradiotherapy; Distant failure; Extended-field radiotherapy; Para-aortic lymphadenectomy