Abstract
Background: The aim of this study is to perform a retrospective analysis of treatment outcomes and toxicity in a group of patients with synchronous metastatic disease in paraaortic lymph nodes (PALU) who underwent extended-field (chemo) radiotherapy at the Institute of Radiation Oncology in Na Bulovce Hospital in Prague in the period 2005-2017. Patients and methods: Over 800 patients with cervical cancer were treated at our department during this period.
Synchronous metastatic involvement limited to PALU was confirmed in 85 (10.6%) patients. Of this number, 57 (67.1%) underwent combined (chemo) radiotherapy with radical intent and 26 (30.6%) underwent palliative radiotherapy.
The median follow-up period in our group of patients was 24 months. Results: In the group of 57 patients treated with radical intent, all patients underwent external radiation (external beam radiation therapy - EBRT) to the pelvis and PALU (extended-field radiation), 55 (96.5%) received brachytherapy (BRT), and 17 (29.8%) were administered concomitant chemotherapy (CHT) with cDDP weekly.
Acute toxicity G3-4 according to RTOG (Radiation Therapy Oncology Group) criteria was noted in 7 (12.3%) patients and late toxicity G3-4 in 7 (12.3%) patients. The treatment of side effects was addressed by multidisciplinary teams.
In the subgroup of patients treated with EBRT + BRT + CHT, the median of progression-free survival (PFS) was 37.3 months, overall survival (OS) was 39.2 months, and the estimated 5-year survival according to the Kaplan-Meier method was 46.8%. In the EBRT + BRT subgroup, the median PFS was 22.7 months, median OS was 30.3 months, and the estimated 5-year survival was 38.6%.
Conclusion: Extended-field (chemo) radiotherapy in advanced cervical cancer with initial metastases to paraaortic lymph nodes confirmed that it significantly improved PFS and OS in our group of patients. Both acute and late toxicity were within acceptable limits.
Intensive multidisciplinary supportive care is necessary to achieve maximum therapeutic benefit.