Gynecological Cancer

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TU_13_3444 - Analysis of Prognostic Factors and Clinical Outcomes in Isolated Paraaortic Lymph Node Recurrence of Uterine Cervical Carcinoma

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

Analysis of Prognostic Factors and Clinical Outcomes in Isolated Paraaortic Lymph Node Recurrence of Uterine Cervical Carcinoma
C. S. Chen, E. Y. Huang, and C. J. Wang; Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan

Purpose/Objective(s): This aim of study was to evaluate clinical outcome and identify clinical and radiologic prognostic factors in patients with isolated para-aortic lymph node (PALN) of cervical cancer.

Materials/Methods: Of a total of 1521 patients treated with curative pelvic radiation therapy for uterine cervical carcinoma, 65 patients who developed para-aortic lymph node recurrence as the first site of tumor progression were retrospectively reviewed between May 1993 and January 2017. Forty-five patients of 65 patients had received salvage therapy. Twenty-five, 11, and 10 patients underwent concurrent chemoradiation, radiation alone, and chemotherapy alone, respectively. Median salvage PALN RT dose was 54Gy (range: 18 to 62Gy). The Kaplan–Meier method was used to calculate the actuarial rate. CT image including maximum PALN long axis, short axis, highest level and longitudinal range of PALN distribution were evaluated. Potential prognostic parameters of overall survival were analyzed with Cox proportional hazards model.

Results: The median follow-up period was 49.8 months (range:4 to 202 months). Median overall survival (OS) was 27.6 months (95%CI, 13.1-42.1 months). In the multivariate analysis, the highest level of PALN metastases at or above L1 spine level was significantly associated with worse OS (hazard ratio [HR] 3.293, 95% confidence interval [CI] 1.126-9.631, P=.030). Patients who received salvage treatment with radiation had improved OS compared to who did not ( HR 0.389, 95% CI 0.177-0.856, p=0.019). In the Cox regression analysis of patients treated with salvage radiation therapy, maximum short-axis diameter of PALNs≧2cm( HR 5.962, 95% CI 1.792-19.837, p=0.004) and presence of at least one clinical symptom among leg edema and back pain( HR 3.128, 95% CI 1.127-8.678, p=0.029) were independent predictors of worse OS.

Conclusion: Highest level of PALN metastases at or above L1 spine level predicted worse OS in isolated PALN recurrence of cervical cancer. Radiation therapy plays an important role in better OS after salvage therapy. Maximum short-axis diameter of PALNs≧2cm and presence of symptoms were associated with poor outcome after salvage radiation therapy. Therefore, periodical surveillance including image studies should be recommended for early detection and treatment of isolated PALN recurrence.

Author Disclosure: C. Chen: None. E. Huang: None.

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