Treatment outcomes and prognostic factors in uterine cervical cancer patients treated with postoperative extended field radiation therapy

Objective: To evaluate treatment outcomes and prognostic factors in uterine cervical cancer patients treated with postoperative extended field radiation therapy (POEFRT) with or without chemotherapy. Methods: Between 1983 and 2006, 35 patients with a pathologically confirmed positive para-aortic node (PAN) or common iliac node (CIN) who underwent a radical hysterectomy with bilateral pelvic lymph node dissection and PAN dissection received POEFRT with (N=23) or without (N=12) chemotherapy. Prognostic factors such as age, stage, size, parametrium invasion, lymphovascular space invasion, nodal station, depth of stromal invasion and use of chemotherapy were analyzed. Results: With a median follow-up of 44 months, the 5-year overall survival (OS), disease-free survival (DFS), distant failure-free survival (DFFS) and loco-regional failure-free survival rates were 51%, 51%, 59% and 93%, respectively. The use of chemotherapy significantly improved the 5-year OS rate (61% vs. 48%, p=0.004), the 5-year DFS rate (54% vs. 38%, p=0.004) and the 5-year DFFS rate (57% vs. 48%, p=0.009). PAN involvement resulted in a compromised 5-year DFS rate (42% vs. 73%, p=0.002) and 5-year DFFS rate (47% vs. 82%, p=0.004) as compared to CIN involvement. Grade 3 or higher hematological toxicity was observed more frequently in patients who received POEFRT combined with chemotherapy as compared to patients who received POEFRT alone (52% vs. 17%, p=0.04). Conclusion: The use of POEFRT resulted in an excellent loco-regional control rate. The addition of chemotherapy may improve outcome in patients who have received POEFRT, but with higher manageable toxicity.PETEREIT DG, 2007, CLIN RAD ONCOLOGY, P1323Kim K, 2006, GYNECOL ONCOL, V101, P398, DOI 10.1016/j.ygyno.2005.10.035STEHMAN FB, 2005, PRINCIPLES PRACTICE, P761Saad A, 2004, AM J CLIN ONCOL-CANC, V27, P256, DOI 10.1097/01.coc.0000092564.16409.cdSood BM, 2002, INT J GYNECOL CANCER, V12, P459GRIGSBY PW, 2001, INT J RADIAT ONCOL, V49, P7338Peters WA, 2000, J CLIN ONCOL, V18, P1606Sedlis A, 1999, GYNECOL ONCOL, V73, P177Varia MA, 1998, INT J RADIAT ONCOL, V42, P1015Grigsby PW, 1998, INT J RADIAT ONCOL, V41, P817HACKER NF, 1995, INT J GYNECOL CANCER, V5, P250VIGLIOTTI AP, 1992, INT J RADIAT ONCOL, V23, P501MALFETANO JH, 1991, GYNECOL ONCOL, V42, P44STEHMAN FB, 1991, CANCER, V67, P2776DELGADO G, 1990, GYNECOL ONCOL, V38, P352PODCZASKI E, 1990, CANCER, V66, P251DELGADO G, 1989, GYNECOL ONCOL, V35, P314LOVECCHIO JL, 1989, GYNECOL ONCOL, V34, P43GASPAR LE, 1989, RADIOLOGY, V172, P271CRAWFORD JS, 1987, RADIOLOGY, V164, P255NORI D, 1985, INT J RADIAT ONCOL, V11, P1469BERMAN ML, 1984, GYNECOL ONCOL, V19, P8