title: Impact of treatment year on survival and adverse effects in patients with cervical cancer and paraortic lymph node metastases treated with definitive extended-field radiation therapy.
abstract: OBJECTIVE
  Treatment for locoregionally advanced cervical cancer has changed dramatically since 2000. In that year, delivery of radiation therapy with concurrent chemotherapy became standard, and in the early 2000s, use of intensity modulated RT (IMRT) and positron emission tomography (PET) became more prevalent. We sought to determine the impact of these changes on disease-specific survival (DSS) and treatment-related adverse effects in patients with cervical cancer with para-aortic lymph node (PAN) metastases treated with definitive extended-field radiation therapy.
  
  
  METHODS
  We reviewed the medical records of 103 patients with cervical cancer with PAN metastases treated with curative intent at our institution during 2000 to 2013. DSS, disease control in PANs, and treatment-associated adverse effects were compared between patient groups defined by treatment year.
  
  
  RESULTS
  The 5-year DSS rate was 23% (95% confidence interval, 9%-38%) for the 34 patients treated from 2000 to 2004, and 47% (95% confidence interval, 36%-59%) for the 69 patients treated from 2005 to 2013 (P = .005). Factors associated with improved DSS included concurrent chemoradiation (P = .001), baseline PET imaging (P = .01), and treatment of PANs with IMRT (P = .02). Only 3 patients (4%) treated from 2005 to 2013 versus 6 patients (18%) treated from 2000 to 2004 had recurrence in PANs (P = .03). Most recurrences in patients treated from 2005 to 2013 were at distant sites. The crude rate of grade 3 or higher late treatment-related adverse effects was 17%; of the 18 patients who developed serious adverse effects, 8 were being treated for recurrent disease at the time. Adverse effects most frequently involved the gastrointestinal and genitourinary systems.
  
  
  CONCLUSIONS
  Outcomes for patients with cervical cancer with PAN metastases have improved concurrently with advances in treatment, including PET and IMRT. Future studies should focus on ways to improve systemic treatments and reduce late adverse effects without compromising local control.
authors.affiliation: Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas.
authors.forename: Eleanor M
authors.initials: EM
authors.lastname: Osborne
authors.affiliation: Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas.
authors.forename: Ann H
authors.initials: AH
authors.lastname: Klopp
authors.affiliation: Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas.
authors.forename: Anuja
authors.initials: A
authors.lastname: Jhingran
authors.affiliation: Department of Gynecologic Oncology, MD Anderson Cancer Center, Houston, Texas.
authors.forename: Larissa A
authors.initials: LA
authors.lastname: Meyer
authors.affiliation: Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas. Electronic address: peifel@mdanderson.org.
authors.forename: Patricia J
authors.initials: PJ
authors.lastname: Eifel
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging / Q000532:radiotherapy; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D049268:Positron-Emission Tomography / Q000379:methods; D011878:Radiotherapy / Q000009:adverse effects* / Q000379:methods*; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods; D015996:Survival Rate; D002583:Uterine Cervical Neoplasms / Q000000981:diagnostic imaging / Q000401:mortality* / Q000473:pathology / Q000532:radiotherapy*