Extended Field Radiotherapy With or Without Chemotherapy in Patients with Cervical Cancer and Positive Para-Aortic Lymph Nodes: a Single Institution Retrospective Review

Background: Positive para-aortic lymph node (PALN) at diagnosis in cervical cancer patients confers anunfavorable prognosis. This study reviewed the outcomes of extended field radiotherapy (EFRT) and concurrentchemotherapy with extended field RT (CCEFRT) in patients with positive PALN at diagnosis. Materials and
Methods: Medical records of 407 cervical cancer patients between 1st January 2002 to 31st December 2012were reviewed. Some 32 cases with positive PALN were identified to have received definitive extended fieldradiotherapy with or without chemotherapy. Treatment outcomes, clinicopathological factors affecting survivaland radiotherapy related acute and late effects were analyzed.
Results: Totals of 13 and 19 patients underwentEFRT and CCEFRT respectively during the period of review. The median follow-up was 70 months. The 5-yearoverall survival (OS) was 40% for patients who underwent CCEFRT as compared to 18% for patients whohad EFRT alone, with median survival sof 29 months and 13 months, respectively. The 5-years progression freesurvival (PFS) for patients who underwent CCEFRT was 32% and 18% for those who had EFRT. Median PFSwere 18 months and 12 months, respectively. Overall treatment time (OTT) less than 8 weeks reduced risk ofdeath by 81% (HR=0.19). Acute side effects were documented in 69.7% and 89.5% of patients who underwentEFRT and CCEFRT, respectively. Four patients (12.5%) developed radiotherapy late toxicity and there was notreatment-related death observed.
Conclusions: CCEFRT is associated with higher 5-years OS and median OScompared to EFRT and with tolerable level of acute and late toxicities in selected patients with cervical cancerand PALN metastasis.