Cancer of the pelvis: definitive three-dimensional conformal radiotherapy for patients with isolated recurrence in the para-aortic lymph nodes

• Published in: Journal of radiation research Vol. 53; no. 5; pp. 735 - 741
• Main Authors: Yahara, Katsuya, Ohguri, Takayuki, Imada, Hajime, Yamaguchi, Shinsaku, Terashima, Hiromi, Korogi, Yukunori
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 01-09-2012
• Subjects: Adult; Aged; Cancer; Cancer patients; Care and treatment; Chemotherapy, Adjuvant; Disease-Free Survival; Failure; Female; Humans; Kaplan-Meier Estimate; Lymph; Lymphatic Metastasis - radiotherapy; Medical research; Middle Aged; Oncology; Patients; Pelvic Neoplasms - drug therapy; Pelvic Neoplasms - radiotherapy; Pelvis; Radiotherapy; Radiotherapy, Conformal; Recurrence; Retrospective Studies; Survival; Three dimensional; Treatment Outcome; Tumors
• ISSN: 0449-3060; 1349-9157
• DOI: 10.1093/jrr/rrs042

The purpose of this study was to evaluate the outcome of definitive three-dimensional conformal radiotherapy (RT) for isolated para-aortic lymph node (LN) recurrence in patients with controlled primary cancer of the pelvis. Twenty-four consecutive patients with isolated para-aortic LN recurrence were retrospectively analyzed. The patients were included in this study if they were eligible to receive definitive RT for abdominal para-aortic LN recurrence with controlled primary cancer of the pelvis without other distant/recurrent diseases. The median time between the front-line therapy and RT for isolated para-aortic LN metastases was 21 months. Nineteen (79%) patients had an objective tumor response. In-field failure occurred in four patients (17%), while failure outside of the irradiated field was recognized in 12 patients (50%). The overall survival, progression-free survival and local control rates at 5 years were 56%, 29% and 72%, respectively. Statistically significant prognostic factors of the overall survival rate in the univariate analyses were an objective tumor response (P = 0.0098) and the time between front-line therapy and RT (P = 0.033). The maximum tumor size was a significant prognostic factor of the overall survival rates in the multivariate analyses (P = 0.046). The toxicities were mild; leukopenia of Grade 3 was detected in one patient, and no Grade 3 or higher non-hematological toxicity was observed. In conclusion, definitive three-dimensional RT for isolated abdominal para-aortic LN recurrence in patients with controlled primary cancer of the pelvis may be feasible, and can provide a relatively longer-term survival. The results justify further investigation of higher dose RT using modern RT planning techniques.