Impact of Treatment Year on Survival and Adverse Effects in Cervical Cancer Patients with Para-Aortic Lymph Node Metastases Treated with Definitive Extended-Field Radiation Therapy

Publication date: Available online 7 September 2016
Source:Practical Radiation Oncology
Author(s): Eleanor M. Osborne, Ann H. Klopp, Anuja Jhingran, Larissa A. Meyer, Patricia J. Eifel
PurposeTreatment for locoregionally advanced cervical cancer has changed dramatically since 2000. In that year, delivery of radiation therapy (RT) 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 cervical cancer patients with para-aortic lymph node (PAN) metastases treated with definitive extended-field RT.Methods and MaterialsWe reviewed the medical records of 103 cervical cancer patients with PAN metastases treated with curative intent at our institution during 2000–2013. DSS, disease control in PANs, and treatment-associated adverse effects were compared between patient groups defined by treatment year.ResultsThe 5-year DSS rate was 23% (95% CI, 9%–38%) for the 34 patients treated during 2000–2004 and 47% (95% CI, 36%–59%) for the 69 patients treated during 2005–2013 (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 during 2005–2013 versus 6 patients (18%) treated during 2000–2004 had recurrence in PANs (P=.03). Most recurrences in patients treated during 2005–2013 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.ConclusionsOutcomes for cervical cancer patients 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.



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