| [Abstract] Para-aortic lymph node metastasis is one of the main prognostic factors for cervical cancer. The para-aortic lymph node metastatic rate increases with the progression of disease stage. Therefor, an important approach for improving the prognosis in cervical cancer patients with para-aoritc lymph node metastasis is early diagnosis followed by proper therapy, as well as prophylactic para-aortic irradiation in high-risk patients.Objective:To analyze and evaluate the clinical outcomes of cervical cancer patients treated by definitive extended field intensity-modulated radiation therapy (EF-IMRT).Methods:We retrospectively analyzed 81 cervical cancer patients with para-aortic lymph node metastasis treated by EF-IMRT in Peking Union Medical College Hospital between May 1st 2008 and Dec 31st 2014.The external beam irradiation dose was 45-50.4Gy, and involved lymph nodes were received a concomitant boost to 56-61.6Gy, some patients with stage IIIB received a related parametrium boost of lOGy. High dose rate(HDR) brachytherapy with Ir192 was prescribed to point A at a dose of 30-36Gy/5-6F.Most patients received chemotherapy based on cisplatin. Results:by the end of the last follow-up,49 patients were alive, the median follow-up time was 29 months(10.6-101.3months). The 2-year overall survival rate(OS). diseases free survival rate(DFS), local control rate(LC) were 61.8%,46.2%,82.3%,respectively. The 3-year OS, DFS, LC were 57.5%.44,1%,82.3%. There were 39 patients relapsed, among which,8 patients(20.5%) had local recurrence only,1 patients(2.6%) had both local recurrence and distant metastasis and 30 patients(76.9%) had distant metastasis only.Tumor size and number of chemotherapy courses were independent predictors of DFS and LC. The percentage of acute grade 3 or greater gastrointestinal(GI), genitourinary(GU) and hematologic complications were 4.9%,3.7%,49.4%. Only 1 patient developed late grade 3 GI and GU complications, and received an operation. Conclusion:Reasonable clinical outcomes can be achieved with EF-IMRT for cervical cancer patients with para-aortic lymph node metastasis, and the toxic complications are acceptable. Distant metastasis is the major failure patterns. The tumor size and number of chemotherapy courses are independent predictors of DFS and LC.Objective:To analyze and evaluate the clinical outcomes of cervical cancer patients treated by prophylactic EF-IMRT. Methods:We retrospectively analyzed 122 cervical cancer patients treated by prophylactic EF-IMRT in Peking Union Medical College Hospital between Apr 1st 2008 and Dec 31st 2014. All patients received external beam irradiation of 45-54Gy, and a concomitant boost to 54.8-66Gy was delivered to involved lymph nodes. Some patients with stage IIIB were received a related parametrium boost of 6-10Gy. HDR brachytherapy with Ir192 was prescribed to point A at a dose of 24-42Gy/4-7F. Most patients received concurrent chemotherapy of weekly cisplatin or paclitaxel. Results:The median follow-up time was 31.6months(3.7-96.1 months), the 3-year OS. DFS. LC were 88.0%,77.7%.91.2%, respectively. The expected 5-year OS, DFS, LC were 85.6%,75.9%,89.0%. By the end of the last follow-up, there were 26 patients relapsed, among which,9(34.6%) patients had local recurrence only,16(61.5%) patients had distant metastasis only,1(3.9%) people had both local recurrence and distant metastasis.The percentage of acute grade 3 or greater GI, GU and hematologic complications were 7.9%.6.7%,67.4%. The percentage of late grade 3 or greater GI, GU and complications were 2.7% and 1.8%. The HGB level before treatment was an independent predictors of OS and DFS. Conclusions:EF-IMRT for cervical cancer patients with high risk of para-aortic lymph node metastasis, has good clinical outcomes, but it still needs prospective study to identify. |
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