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KMID : 0859320100280030125
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Journal of the Korean Society for Therapeutic Radiology and Oncology
2010 Volume.28 No. 3 p.125 ~ p.132
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Effects of Concurrent Chemotherapy and Postoperative Prophylactic Paraaortic Irradiation for Cervical Cancer with Common Iliac Node Involvement
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Han Tae-Jin
Wu Hong-Gyun
Kim Hak-Jae
Ha Sung-Whan
Kang Soon-Beom
Song Yong-Sang
Park Noh-Hyun
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Abstract
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Purpose:To retrospectively assess the advantages and side effects of prophylactic Paraaortic irradiation in
cervical cancer patients with common iliac nodal involvement, the results for survival, patterns of failure, and treatment-related toxicity.
Methods:From May 1985 to October 2004, 909 patients with cervical carcinoma received postoperative radiotherapy at the Seoul National University Hospital. Among them, 54 patients with positive common iliac nodes on pathology and negative Paraaortic node were included in the study. In addition, 44 patients received standard pelvic irradiation delivered 50.4 Gy per 28 fractions (standard irradiation group), and chemotherapy was combined in 16 of them. The other 10 patients received pelvic irradiation at a dose of 50.4 Gy per 28 fractions in addition to Paraaortic irradiation at 45 Gy per 25 fractions (extended irradiation group). In addition, all of them received chemotherapy in combination with radiation. Follow-up times for pelvic and Paraaortic irradiation ranged from 6 to 201 months (median follow-up time, 58 months) and 21 to 58 months (median follow-up time, 47 months), respectively.
Results:The 4-year overall survival, disease free survival, and distant metastasis free survival in the standard
irradiation group and extended irradiation group were 67.2% vs. 90.0% (p=0.291), 59.0% vs. 70.0% (p=0.568) and 67.5% vs. 90.0% (p=0.196), respectively. The most common site of first failure for the standard irradiation group was the paraaortic lymph node, while no paraaortic failure was observed in the extended irradiation group. Relatively, hematologic toxicity grade 3 or greater was common in the extended irradiation group (2/10 extended vs. 2/44 standard), while gastrointestinal toxicity of grade 3 or greater was lower (2/10 extended vs. 6/44 standard), and urologic toxicity of grade 3 or greater was observed in the standard irradition group only (0/10 vs. 3/44).
Conclusions:Concurrent chemotherapy and prophylactic Paraaortic irradiation in patients with common iliac nodal
involvement showed slightly improved clinical outcomes aside from increased hematologic toxicity, which was statistically insignificant. Considering the relatively small number of patients and short follow-up times, additional studies are needed to obtain more conclusive outcomes.
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KEYWORD
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Cervical cancer, Radiotherapy, Common iliac lymph node, Paraaortic irradiation
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