Development of paraaortic lymph nodes metastases in carcinoma of the cervix: analysis of treatment outcome.

Purpose: To evaluate treatment outcomes in patients with cervical cancer and paraaortic lymph nodes metastases using radiotherapy (RT), chemotherapy (CT), or chemo/radiotherapy (CT/RT).

Patients And Methods: From 184 stage IIB-IVA patients with cervical cancer who were randomly treated with RT or CT/RT, 15 relapsed after the initial therapy only in the paraaortic lymph nodes. The median age of these 15 patients was 53 years (range 30-69). Fourteen patients had squamous cell carcinoma and one adenocarcinoma. The initial stage was IIB (n=3), and IIIB (n=12). The treatment consisted of RT to the paraaortic region (3 patients), CT (4 patients 4-6 cycles) and CT/RT sequentially (8 patients 1-2 cycles of CT before RT and 4 cycles after RT). RT was delivered as external beam radiotherapy (EBRT), total dose 45 Gy, 24 fractions, antero-posterior (AP)/postero-anterior (PA) field technique.

Results: With median follow up of 7 months (range 4-24), the 2-year overall survival (OS) was 17%. There was no difference in OS between therapy groups. CT/RT had not significant impact on OS. There were 7 (46.6%) objective responses (complete response-CR-5/15 and partial response-PR-2/15 patients; the best response was seen in the CT/RT group (5/8 patients). Treatments were well tolerated, while 40% of the 15 patients experienced late complications. There was no significant correlation between the initial patient therapy (RT vs. concurrent CT/RT) and the development of metastases in the paraaortic region (median time to relapse 5 vs. 6 months, respectively).

Conclusion: Development of metastatic disease of cervical carcinoma to the paraaortic lymph nodes is associated with poor prognosis and the treatment has palliative aim. The use of different therapy approaches didn't improve the therapeutic ratio. The sequential use of CT/RT might improve results but further studies are needed.