Is a Low Dose of Concomitant Chemotherapy With Extended-Field Radiotherapy Acceptable as an Efficient Treatment for Cervical Cancer Patients With Metastases to the Para-Aortic Lymph Nodes?

Kazumoto, Tomoko; Kato, Shingo; Yokota, Harushige; Hasumi, Youko; Kino, Nao; Horie, Kouji; Yoshida, Daisaku; Mizukami, Tatsuji; Saito, Yoshihiro

doi:10.1097/igc.0b013e318226f657

Cited by 8 publications

(9 citation statements)

References 23 publications

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“…In fact, none of the patients whose PALN dose was ≥50.4 Gy had an in-field PALN recurrence. Kazumoto et al reported that 93.8% of PALN was controlled using a PALN dose 54–60 Gy [24]. This is compatible with the results of the present study, and an adequate dose to PALN is suggested.…”

Section: Discussionsupporting

confidence: 92%

“…Although only two patients (7.7%) in our study showed pathologic evidence of PALN involvement, the EFRT outcome was comparable to those reported in other studies. The Kazumoto study, with similarly diagnosed criteria and treatment techniques, reported outcomes including tolerability and control rate of low-dose cisplatin with EFRT in patients with PALN metastases diagnosed by CT imaging [24]. A higher PALN dose than in our study can result in a higher 5-year OS (56.3%) with feasible tolerability.…”

Section: Discussionmentioning

confidence: 68%

“…Therefore, the size criterion of >1 cm was deemed acceptable in our study. As in the present study, Kazumoto et al used the >1 cm criterion in their report of treatment outcomes [24]. FDG-PET scanning showed a sensitivity of 75% and a specificity of 92% for detecting PALN metastasis [25].…”

Section: Discussionmentioning

confidence: 92%

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Prognostic factors associated with radiotherapy for cervical cancer with computed tomography-detected para-aortic lymph node metastasis

Huang

et al. 2013

Journal of Radiation Research

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Patients with cervical cancer diagnosed with a para-aortic lymph node (PALN) metastasis by computed tomography (CT) scan were analyzed to identify associated prognostic factors. A total of 55 patients were reviewed, and 27 of these patients underwent extended-field radiotherapy (EFRT). The median PALN dose in patients receiving EFRT was 45 Gy (range, 27–57.6 Gy). Of the 55 patients, 28 underwent pelvic radiotherapy (RT); concurrent chemoradiotherapy (CCRT) was administered to 41 patients. The Kaplan–Meier method was used to calculate the actuarial rate. Multivariate analysis was performed using the Cox proportional hazards model. Five-year overall survival (OS) rates were 41% and 17.9% in patients undergoing EFRT and pelvic RT (P = 0.030), respectively. Age < 53 years (P = 0.023), FIGO Stage I–II (P = 0.002), and treatment with EFRT (P = 0.003) were independent predictors of better OS. The use of CCRT (P = 0.014), Stage I–II (P = 0.002), and treatment using EFRT (P = 0.036) were independent predictors of distant metastasis. In patients undergoing EFRT plus CCRT, the 5-year OS was 50%. Three-year PALN disease-free rates were 8.8%, 57.9% and 100% (P < 0.001) in CCRT patients who received PALN doses of 0 Gy, ≤45 Gy and ≥50.4 Gy, respectively. Although PALN metastasis is thought to be distant metastasis in cervical cancer, EFRT plus CCRT shows a good outcome, particularly in younger patients in an early FIGO stage. Cervical cancer with a PALN metastasis should not be considered incurable. Doses ≥50.4 Gy for treating PALN may result in better disease control.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 68%

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Prognostic factors associated with radiotherapy for cervical cancer with computed tomography-detected para-aortic lymph node metastasis

Huang

et al. 2013

Journal of Radiation Research

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“…For patients initially diagnosed with PAN metastasis, the efficacy of concurrent chemotherapy seems to be uncertain. Since Stryker et al reported that cisplatin-based chemotherapy may be beneficial [ 3 ], many studies have continued to report favorable outcomes, despite more acute severe hematologic and gastrointestinal toxicity [ 7 - 9 , 17 , 18 ]. In reviewing our results, we did not observe a significant survival benefit for the addition of concurrent chemotherapy to EFRT, although the group that received EFRT alone included more patients with disease of advanced stage (p < 0.001, Additional file 1 : Table S2).…”

Section: Discussionmentioning

confidence: 99%

“…In some prospective and retrospective trials with EFRT plus concurrent chemotherapy, severe toxicity of EFRT plus concurrent chemotherapy, including gastrointestinal or hematologic toxicity, was observed despite a favorable survival rate [ 6 - 8 ]. Therefore, some investigators have tried to reduce the toxicity of EFRT plus concurrent chemotherapy using intensity-modulated radiotherapy or low dose chemotherapy [ 9 , 10 ]. However, despite a large number of small population studies, the effect of EFRT with or without concurrent chemotherapy has still not been elucidated.…”

Section: Introductionmentioning

confidence: 99%

Treatment outcomes of extended-field radiation therapy and the effect of concurrent chemotherapy on uterine cervical cancer with para-aortic lymph node metastasis

et al. 2015

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PurposeTo review the clinical outcomes of extended-field radiation therapy (EFRT) and to analyze prognostic factors significant for survival in patients receiving EFRT for uterine cervical carcinoma with para-aortic node (PAN) metastasis.Patients and methodsWe retrospectively reviewed 90 patients with stage IB-IVA cervical cancer and PAN metastasis between 1987 and 2012. Median age was 50 (range, 24–77). Patients received median 70.2 Gy (range, 56–93) to point A and median 50.4 Gy (range, 45–60.4) to PAN over median 69 elapsed days (range, 43–182). Forty-six patients (51.1%) received concurrent chemotherapy. Survival was calculated using the Kaplan–Meier method. We analyzed prognostic factors for overall actuarial survival (OS) and progression-free survival (PFS) using a Cox regression method.ResultsThe median follow-up period for surviving patients was 55 months (range, 3–252). Seventy patients (77.8%) had complete remission. Forty-six patients experienced treatment failure as follows: 11 patients (12.2%) as local recurrence, 19 (21%) as regional recurrence and 33 (36.7%) as distant metastasis. The 5-yr OS and PFS were 62.6% and 43.9%, respectively. Treatment response was the only statistically independent prognostic factors for OS (p= 0.04) and PFS (p< 0.001) on multivariate analysis. Grade 3 or 4 hematologic gastrointestinal and urogenital toxicities were observed in about 10% of patients.ConclusionsOur institutional experiences showed that EFRT was an effective treatment for cervical cancer patients with PAN metastasis. The addition of chemotherapy to EFRT seems to have uncertain survival benefit with higher hematologic toxicity.Electronic supplementary materialThe online version of this article (doi:10.1186/s13014-014-0320-5) contains supplementary material, which is available to authorized users.

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Feasibility of extended-field irradiation and intracavitary brachytherapy combined with weekly cisplatin chemosensitization for IB2–IIIB cervical cancer with positive paraaortic or high common iliac lymph nodes: a retrospective review

et al. 2013

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Is a Low Dose of Concomitant Chemotherapy With Extended-Field Radiotherapy Acceptable as an Efficient Treatment for Cervical Cancer Patients With Metastases to the Para-Aortic Lymph Nodes?

Cited by 8 publications

References 23 publications

Prognostic factors associated with radiotherapy for cervical cancer with computed tomography-detected para-aortic lymph node metastasis

Prognostic factors associated with radiotherapy for cervical cancer with computed tomography-detected para-aortic lymph node metastasis

Treatment outcomes of extended-field radiation therapy and the effect of concurrent chemotherapy on uterine cervical cancer with para-aortic lymph node metastasis

Feasibility of extended-field irradiation and intracavitary brachytherapy combined with weekly cisplatin chemosensitization for IB2–IIIB cervical cancer with positive paraaortic or high common iliac lymph nodes: a retrospective review

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