Treatment Outcomes Of Extended-field Radiation Therapy And Prognostic Factors On Cervical Cancer With Para-aortic Lymph Node Metastasis

Purpose:To review the clinical outcomes of extended field radiationtherapy for cervical cancer patients with para-aortic lymph node metastasis.Patients and methods:We analysed 67 cervical cancer patients with para-aortic lumph node metastasis from January2012 to June 2016.Median age was 53.Patients received a total dose of 82.7Gy.Para aortic and pelvic lymph node received 53-60 Gy by using simultaneous modulated accelerated radiotherapy(SMART).54patients(80%)received concurrent chemotherapy.At the end of radiotherapy,35 patients received1-6cycles TP sequential chemotherapy.We use the Kaplan-Meier method to calculated survival.Univariate analysis was performed using Log-Rank test.Multivariate analysis was performed using a Cox regression method.Results: The median follow-up period for surviving patients was 18 months(range,6-51).53 patients had CR.14 patients had PR.No PD or SD was observed.29 patients experienced treatment failure:13 patients occurred local recurrence only,5 cases of local recurrence combined withdistant metastasis,11 cases occurred distant metastasis only.The 3-year OS and PFS for all patients were 65% and 44%,respectively.Treatment response and concurrent chemotherapy were statistically independent prognostic factors for OS and PFS,respectively.The incidence of grade 3-4 hematologic gastrointestinal and urogenital toxicities was 59.7% and7.4%,respectively.Conclusions: Our study show that EF-IMRT with concurrent chemotherapy is an effective treatment for cervical cancer patients with para-aortic lymph node metastasis.Platinum based concurrent chemotherapy have survival benefit.