Para-aortic lymphatic failure occurred in 14.5% of patients in our study. Para-aortic failures occurred in 17.7% of patients with ≥ 3 lymph nodes and in 19.5% of patients with pelvic lymph nodes ≥ 1.5 cm. This may suggest the need for escalation of radiotherapy or chemotherapy in these patients.
Alfredo Echeverria, MD, Umang Patel, MD, John Shumway, BA, Mark Bonnen, MD, Michelle Ludwig, MD, MPH, PhD; Baylor College of Medicine
PURPOSE: To identify factors at the time of presentation that predict for para-aortic lymphatic failures after definitive chemoradiation and to map out specific patterns of nodal failure.
METHODS: We identified 138 patients with IB1–IVA cervical cancer treated with definitive chemoradiation between 2008 and 2014. Information on tumor size and stage was gathered. The number, size, and specific lymph node location were recorded before therapy and at the time of any failure. Treatment-related data included modality, dose, and fields of radiation, as well as the number of chemotherapy cycles.
RESULTS: Eighty-two (59.0%) patients presented with nodal disease, all of whom had pelvic lymph node involvement, with a mean of six involved nodes. Thirty-three (23.7%) presented with para-aortic chain involvement and a mean of five involved nodes. Mean primary tumor volume was 131.7 cc. Median follow-up was 23 months. Two-year progression-free survival (PFS) and overall survival (OS) were 69% (standard error [SE], 0.04) and 88% (SE, 0.03), respectively. Tumor size at presentation (P = .003), fewer cycles of chemotherapy (P = .02), and ≥ 3 lymph nodes (P = .00) were adversely associated with PFS. Locoregional and distant failures occurred in 24 (17.3%) and 18 (12.9%) patients, respectively. There was a 10.1% rate of primary site failures vs 6.5% in the pelvic lymph nodes, 1.4% in the inguinal lymph nodes, and 14.5% in the para-aortic chains. Patients at higher risk for para-aortic failure were those with lymph nodes ≥ 1.5 cm in the shortest axis (19.5% vs 7.8%; P = .05) and those with ≥ 3 involved pelvic nodes (17.7% vs 5.8%; P = .03).
CONCLUSIONS: Para-aortic lymphatic failure occurred in 14.5% of patients in our study. Para-aortic failures occurred in 17.7% of patients with ≥ 3 lymph nodes and in 19.5% of patients with pelvic lymph nodes ≥ 1.5 cm. This may suggest the need for escalation of radiotherapy or chemotherapy in these patients.
Proceedings of the 98th Annual Meeting of the American Radium Society - americanradiumsociety.org