The Significance of Para-Aortic Nodal Size and the Role of Adjuvant Systemic Chemotherapy in Cervical Cancer An Institutional Experience

Dustin B. Manders, Travis T. Sims, April Bailey, Lindsay Hwang, Debra L Richardson, David S Miller, Siobhan M Kehoe, Kevin Albuquerque, Jayanthi S Lea

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Objective: Cervical cancer metastatic to the para-aortic lymph nodes (PALNs) carries a poor prognosis. Despite extended-field radiation therapy (EFRT), only 30% to 50% of patients will survive 3 years. We sought to examine the treatment regimens used, associated toxicities, and treatment outcomes in patients with cervical cancer metastatic to PALN. Methods: A retrospective review was performed of all patients with cervical cancer treated at a single institution between January 1, 2007 and November 1, 2014. Included patients had PALN metastases as the most distant site of disease, and all treatment plans were designated as curative. Excluded patients had other distant disease or treatment plans considered palliative. Standard treatment consisted of EFRT with concurrent platinum-based chemotherapy. Results: Fifty-one of 344 patients (14.8%) fulfilled the inclusion criteria. The median age was 48.4 years. Forty-four patients received standard EFRT; 7 also received adjuvant platinum/taxane chemotherapy. Thirtynine of 51 (76%) of patients achieved a complete response to primary treatment. Twelve of 51 (24%) had persistent disease or progression at the completion of treatment. Of responders, 15 of 39 (38%) recurred for an overall treatment failure rate of 27 of 51 (53%). Nineteen of 27 (70%) of treatment failures occurred outside the radiated field. Adjuvant chemotherapy following EFRT was not predictive of progression-free survival or overall survival. PALN diameter =1 cm was a significant negative prognostic indicator for overall survival. Conclusions: Over half of patients with cervical cancer metastatic to the PALN failed extended-field chemoradiation. Most failures occurred outside the radiated field suggesting PALN involvement is a surrogate marker of systemic disease. These findings underscore the need for effective systemic therapy, especially in patients with PALN = 1 cm in size.

Original languageEnglish (US)
Pages (from-to)1225-1230
Number of pages6
JournalAmerican Journal of Clinical Oncology: Cancer Clinical Trials
Volume41
Issue number12
DOIs
StatePublished - Dec 1 2018

Fingerprint

Adjuvant Chemotherapy
Uterine Cervical Neoplasms
Lymph Nodes
Radiotherapy
Platinum
Treatment Failure
Therapeutics
Drug Therapy
Survival
Disease-Free Survival
Disease Progression
Biomarkers
Neoplasm Metastasis

Keywords

  • cervical cancer
  • extended-field radiation
  • para-aortic lymph nodes
  • platinum-based chemotherapy
  • surrogate marker

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

@article{74e92875a0114399aa917e5ee8f4e319,
title = "The Significance of Para-Aortic Nodal Size and the Role of Adjuvant Systemic Chemotherapy in Cervical Cancer An Institutional Experience",
abstract = "Objective: Cervical cancer metastatic to the para-aortic lymph nodes (PALNs) carries a poor prognosis. Despite extended-field radiation therapy (EFRT), only 30{\%} to 50{\%} of patients will survive 3 years. We sought to examine the treatment regimens used, associated toxicities, and treatment outcomes in patients with cervical cancer metastatic to PALN. Methods: A retrospective review was performed of all patients with cervical cancer treated at a single institution between January 1, 2007 and November 1, 2014. Included patients had PALN metastases as the most distant site of disease, and all treatment plans were designated as curative. Excluded patients had other distant disease or treatment plans considered palliative. Standard treatment consisted of EFRT with concurrent platinum-based chemotherapy. Results: Fifty-one of 344 patients (14.8{\%}) fulfilled the inclusion criteria. The median age was 48.4 years. Forty-four patients received standard EFRT; 7 also received adjuvant platinum/taxane chemotherapy. Thirtynine of 51 (76{\%}) of patients achieved a complete response to primary treatment. Twelve of 51 (24{\%}) had persistent disease or progression at the completion of treatment. Of responders, 15 of 39 (38{\%}) recurred for an overall treatment failure rate of 27 of 51 (53{\%}). Nineteen of 27 (70{\%}) of treatment failures occurred outside the radiated field. Adjuvant chemotherapy following EFRT was not predictive of progression-free survival or overall survival. PALN diameter =1 cm was a significant negative prognostic indicator for overall survival. Conclusions: Over half of patients with cervical cancer metastatic to the PALN failed extended-field chemoradiation. Most failures occurred outside the radiated field suggesting PALN involvement is a surrogate marker of systemic disease. These findings underscore the need for effective systemic therapy, especially in patients with PALN = 1 cm in size.",
keywords = "cervical cancer, extended-field radiation, para-aortic lymph nodes, platinum-based chemotherapy, surrogate marker",
author = "Manders, {Dustin B.} and Sims, {Travis T.} and April Bailey and Lindsay Hwang and Richardson, {Debra L} and Miller, {David S} and Kehoe, {Siobhan M} and Kevin Albuquerque and Lea, {Jayanthi S}",
year = "2018",
month = "12",
day = "1",
doi = "10.1097/COC.0000000000000458",
language = "English (US)",
volume = "41",
pages = "1225--1230",
journal = "American Journal of Clinical Oncology",
issn = "0277-3732",
publisher = "Lippincott Williams and Wilkins",
number = "12",

}

TY - JOUR

T1 - The Significance of Para-Aortic Nodal Size and the Role of Adjuvant Systemic Chemotherapy in Cervical Cancer An Institutional Experience

AU - Manders, Dustin B.

AU - Sims, Travis T.

AU - Bailey, April

AU - Hwang, Lindsay

AU - Richardson, Debra L

AU - Miller, David S

AU - Kehoe, Siobhan M

AU - Albuquerque, Kevin

AU - Lea, Jayanthi S

PY - 2018/12/1

Y1 - 2018/12/1

N2 - Objective: Cervical cancer metastatic to the para-aortic lymph nodes (PALNs) carries a poor prognosis. Despite extended-field radiation therapy (EFRT), only 30% to 50% of patients will survive 3 years. We sought to examine the treatment regimens used, associated toxicities, and treatment outcomes in patients with cervical cancer metastatic to PALN. Methods: A retrospective review was performed of all patients with cervical cancer treated at a single institution between January 1, 2007 and November 1, 2014. Included patients had PALN metastases as the most distant site of disease, and all treatment plans were designated as curative. Excluded patients had other distant disease or treatment plans considered palliative. Standard treatment consisted of EFRT with concurrent platinum-based chemotherapy. Results: Fifty-one of 344 patients (14.8%) fulfilled the inclusion criteria. The median age was 48.4 years. Forty-four patients received standard EFRT; 7 also received adjuvant platinum/taxane chemotherapy. Thirtynine of 51 (76%) of patients achieved a complete response to primary treatment. Twelve of 51 (24%) had persistent disease or progression at the completion of treatment. Of responders, 15 of 39 (38%) recurred for an overall treatment failure rate of 27 of 51 (53%). Nineteen of 27 (70%) of treatment failures occurred outside the radiated field. Adjuvant chemotherapy following EFRT was not predictive of progression-free survival or overall survival. PALN diameter =1 cm was a significant negative prognostic indicator for overall survival. Conclusions: Over half of patients with cervical cancer metastatic to the PALN failed extended-field chemoradiation. Most failures occurred outside the radiated field suggesting PALN involvement is a surrogate marker of systemic disease. These findings underscore the need for effective systemic therapy, especially in patients with PALN = 1 cm in size.

AB - Objective: Cervical cancer metastatic to the para-aortic lymph nodes (PALNs) carries a poor prognosis. Despite extended-field radiation therapy (EFRT), only 30% to 50% of patients will survive 3 years. We sought to examine the treatment regimens used, associated toxicities, and treatment outcomes in patients with cervical cancer metastatic to PALN. Methods: A retrospective review was performed of all patients with cervical cancer treated at a single institution between January 1, 2007 and November 1, 2014. Included patients had PALN metastases as the most distant site of disease, and all treatment plans were designated as curative. Excluded patients had other distant disease or treatment plans considered palliative. Standard treatment consisted of EFRT with concurrent platinum-based chemotherapy. Results: Fifty-one of 344 patients (14.8%) fulfilled the inclusion criteria. The median age was 48.4 years. Forty-four patients received standard EFRT; 7 also received adjuvant platinum/taxane chemotherapy. Thirtynine of 51 (76%) of patients achieved a complete response to primary treatment. Twelve of 51 (24%) had persistent disease or progression at the completion of treatment. Of responders, 15 of 39 (38%) recurred for an overall treatment failure rate of 27 of 51 (53%). Nineteen of 27 (70%) of treatment failures occurred outside the radiated field. Adjuvant chemotherapy following EFRT was not predictive of progression-free survival or overall survival. PALN diameter =1 cm was a significant negative prognostic indicator for overall survival. Conclusions: Over half of patients with cervical cancer metastatic to the PALN failed extended-field chemoradiation. Most failures occurred outside the radiated field suggesting PALN involvement is a surrogate marker of systemic disease. These findings underscore the need for effective systemic therapy, especially in patients with PALN = 1 cm in size.

KW - cervical cancer

KW - extended-field radiation

KW - para-aortic lymph nodes

KW - platinum-based chemotherapy

KW - surrogate marker

UR - http://www.scopus.com/inward/record.url?scp=85056803750&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85056803750&partnerID=8YFLogxK

U2 - 10.1097/COC.0000000000000458

DO - 10.1097/COC.0000000000000458

M3 - Article

C2 - 29782361

AN - SCOPUS:85056803750

VL - 41

SP - 1225

EP - 1230

JO - American Journal of Clinical Oncology

JF - American Journal of Clinical Oncology

SN - 0277-3732

IS - 12

ER -