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

Szu Yuan Wu, Eng Yen Huang, Chan Chao Chanchien, Hao Lin, Chong Jong Wang, Li Min Sun, Hui Chun Chen, Fu Min Fang, Hsuan Chih Hsu, Yu Jie Huang

Research output: Contribution to journalArticle

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Abstract

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.

Original languageEnglish
Pages (from-to)129-138
Number of pages10
JournalJournal of Radiation Research
Volume55
Issue number1
DOIs
Publication statusPublished - 2014

Fingerprint

lymphatic system
metastasis
Uterine Cervical Neoplasms
radiation therapy
Radiotherapy
tomography
Lymph Nodes
cancer
Tomography
Neoplasm Metastasis
Chemoradiotherapy
dosage
Survival
predictions
Proportional Hazards Models
hazards
Multivariate Analysis
Survival Rate

Keywords

  • cervical cancer
  • concurrent chemoradiotherapy
  • extended-field
  • para-aortic lymph node
  • prognostic factors

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Radiation
  • Health, Toxicology and Mutagenesis
  • Medicine(all)

Cite this

Prognostic factors associated with radiotherapy for cervical cancer with computed tomography-detected para-aortic lymph node metastasis. / Wu, Szu Yuan; Huang, Eng Yen; Chanchien, Chan Chao; Lin, Hao; Wang, Chong Jong; Sun, Li Min; Chen, Hui Chun; Fang, Fu Min; Hsu, Hsuan Chih; Huang, Yu Jie.

In: Journal of Radiation Research, Vol. 55, No. 1, 2014, p. 129-138.

Research output: Contribution to journalArticle

Wu, SY, Huang, EY, Chanchien, CC, Lin, H, Wang, CJ, Sun, LM, Chen, HC, Fang, FM, Hsu, HC & Huang, YJ 2014, 'Prognostic factors associated with radiotherapy for cervical cancer with computed tomography-detected para-aortic lymph node metastasis', Journal of Radiation Research, vol. 55, no. 1, pp. 129-138. https://doi.org/10.1093/jrr/rrt086
Wu, Szu Yuan ; Huang, Eng Yen ; Chanchien, Chan Chao ; Lin, Hao ; Wang, Chong Jong ; Sun, Li Min ; Chen, Hui Chun ; Fang, Fu Min ; Hsu, Hsuan Chih ; Huang, Yu Jie. / Prognostic factors associated with radiotherapy for cervical cancer with computed tomography-detected para-aortic lymph node metastasis. In: Journal of Radiation Research. 2014 ; Vol. 55, No. 1. pp. 129-138.
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abstract = "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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AU - Wang, Chong Jong

AU - Sun, Li Min

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AB - 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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