Gynecological Cancer

PV QA 4 - Poster Viewing Q&A 4

TU_15_3470 - Clinical Outcome of the Recurrence of Uterine Cervical Cancer in Isolated Para-aortic Lymph Node after definitive treatment

Tuesday, October 23
2:45 PM - 4:15 PM
Location: Innovation Hub, Exhibit Hall 3

Clinical Outcome of the Recurrence of Uterine Cervical Cancer in Isolated Para-aortic Lymph Node after definitive treatment
H. Kubota1, K. Tsujino2, N. S. Sulaiman1, S. Sekii1, Y. Matsumoto1, Y. Ota1, and S. Yamaguchi1; 1Hyogo Cancer Center, Akashi, Japan, 2Department of Radiation Oncology, Hyogo Cancer Center, Hyogo, Japan

Purpose/Objective(s): To evaluate the clinical outcome of the recurrence of cervical cancer in isolated para-aortic lymph nodes (PALN).

Materials/Methods: The cases of 50 patients first diagnosed with isolated PALN metastasis after definitive treatment of cervical cancer from 2002 to 2016 at our institution were reviewed for this retrospective study. Forty patients presented with squamous cell carcinoma and 10 with other histopathology. Eleven patients had initial FIGO stage I disease, 24 had stage II, 10 had stage III, and 5 had stage IV. They were initially treated with radiation therapy (RT) alone, concurrent chemoradiation therapy (CCRT), or surgery for cervical cancer. Statistical analysis included construction of overall survival (OS), local control rate (LCR), and progression-free survival (PFS) curves using the Kaplan‑Meier method. Possible prognostic factors, including histopathology, initial FIGO stage, initial treatment, age at recurrence, tumor marker, duration between the end of initial treatment and recurrence, maximum size of the metastatic lesion, number of metastases, SUV max of the metastases, and the treatment method for recurrence, were evaluated using the log-rank test.

Results: The median follow-up time for living patients was 52 months (range: 13‑132 months). The median age at diagnosis of recurrence was 57 years (range: 26‑84 years). The median duration between the end of initial treatment and recurrence was 10 months (range: 1‑91 months). The median maximum size of the metastatic lesion was 17 mm (range: 8‑60 mm). Twenty-five patients had one or two PALN metastases, while 25 patients had more than three. Eighteen patients were treated for recurrence with RT alone, 7 with CCRT, 3 with surgery, 17 with chemotherapy, and 5 with best supportive care (BSC). The median RT dose used for RT alone or CCRT was 55 Gy (range: 50‑58 Gy). The RT target volume was the regional PALN area followed by PALN metastases, except in one patient in whom the target volume was the regional pelvic and PALN areas. The 3- and 5-year OS rates of all patients were 47.0% and 36.2%, respectively. In particular, the 3-year OS rate of patients who underwent CCRT for recurrence was 85.7%, surgery 66.7%, chemotherapy 48.8%, RT 41.3%, and BSC 0% (p = 0.014). Only the treatment method for recurrence was significantly associated with OS. The 3-year LCR and PFS for CCRT was 100% and 71.4%, for surgery, 100% and 66.7%; for chemotherapy, 33.6% and 13.7%; and for RT, 55.5% and 14.1%, respectively (LCR: p = 0.028, PFS: p = 0.059). The number of metastatic lesion and treatment method for recurrence were significantly associated with LCR. Age at recurrence, tumor marker, and number of metastatic lesion were significantly associated with PFS.

Conclusion: Current data suggest that CCRT may be effective in preventing local progression of disease recurrence exclusively in the PALN and may improve the OS of patients.

Author Disclosure: H. Kubota: None. K. Tsujino: None. N. Sulaiman: None. S. Sekii: None. Y. Matsumoto: None. Y. Ota: None.

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