M S Yoon1, W Park2, S J Huh3, H J Kim9, Y S Kim5, Y B Kim6, J-Y Kim7, J-H Lee8, H J Kim9, J Cha10, J H Kim11, J Kim12, W S Yoon13, J H Choi14, M Chun15, Y Choi16, S K Chang17, K K Lee18, M Kim19, J-U Jeong1, T-K Nam20. 1. Department of Radiation Oncology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Jeollanam-do, Republic of Korea. 2. Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea. Electronic address: wonro.park@samsung.com. 3. Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea. 4. Department of Radiation Oncology, Seoul National University Hospital, Seoul, Republic of Korea. 5. Department of Radiation Oncology, Asan Medical Center, Seoul, Republic of Korea. 6. Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Republic of Korea. 7. Center for Uterine Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea. 8. Department of Radiation Oncology, St. Vincent's Hospital, The Catholic University of Korea, College of Medicine, Suwon, Republic of Korea. 9. Department of Radiation Oncology, Inha University School of Medicine, Incheon, Republic of Korea. 10. Department of Radiation Oncology, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea. 11. Department of Radiation Oncology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Republic of Korea. 12. Department of Radiation Oncology, Cheil General Hospital and Women's Healthcare Center, Kwandong University, College of Medicine, Seoul, Republic of Korea. 13. Department of Radiation Oncology, Korea University College of Medicine, Seoul, Republic of Korea. 14. Department of Radiation Oncology, Chung-Ang University Hospital, Seoul, Republic of Korea. 15. Department of Radiation Oncology, Ajou University School of Medicine, Suwon, Republic of Korea. 16. Department of Radiation Oncology, Dong-A University School of Medicine, Busan, Republic of Korea. 17. Department of Radiation Oncology, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea. 18. Department of Radiation Oncology, University of Wonkwang School of Medicine, Iksan, Republic of Korea. 19. Department of Radiation Oncology, Incheon St. Marys Hospital, The Catholic University of Korea, Incheon, Republic of Korea. 20. Department of Radiation Oncology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Jeollanam-do, Republic of Korea. Electronic address: tknam@chonnam.ac.kr.
Abstract
AIM: We investigated the role of paraaortic lymph node dissection (PALND) in patients with stage IIIC1 endometrial carcinoma after surgery followed by adjuvant radiotherapy (RT) alone or chemoradiotherapy (CTRT). METHODS: We performed a subgroup analysis in 151 patients treated with adjuvant pelvic RT. Paraaortic-recurrence free survival, disease-free survival (DFS) and overall survival (OS) were analyzed. RESULTS: In adjuvant RT alone, PALND was significantly related to reduced risk of paraaortic recurrence (0% vs. 17.1%) and distant metastasis (4.5% vs. 19.5%) compared with the no PALND group. PALND affected 5-year DFS (90.2% vs. 58.9%, p = 0.016) and OS (100% vs. 83.1%, p = 0.022). For the CTRT group, the paraaortic recurrence rate was 19.5% for the no PALND group and 12.8% for the PALND group (p = 0.682). Of patients who underwent PALND in the CTRT group, less extensive PALND was significantly related to increased paraaortic recurrence (≤10 vs. >10 dissected LNs, 17.1% vs. 0%). In the no PALND group (n = 82), 5-year paraaortic-recurrence free survival was 79.4% for the CTRT group and 76.2% for the RT alone group (p = 0.941). In multivariate analysis, PALND was significantly associated with reduced risk of disease-specific death (HR, 0.50; 95% CI, 0.26-0.96; p = 0.037). CONCLUSION: PALND provided excellent paraaortic control and improved outcome in stage IIIC1 endometrial cancer with favorable tumor features treated with adjuvant RT alone. Less extensive PALND was associated with significantly increased paraaortic recurrence in patients with advanced tumor features treated with adjuvant CTRT. Combined CTRT did not affect disease control in the paraaortic region compared with RT alone.
AIM: We investigated the role of paraaortic lymph node dissection (PALND) in patients with stage IIIC1 endometrial carcinoma after surgery followed by adjuvant radiotherapy (RT) alone or chemoradiotherapy (CTRT). METHODS: We performed a subgroup analysis in 151 patients treated with adjuvant pelvic RT. Paraaortic-recurrence free survival, disease-free survival (DFS) and overall survival (OS) were analyzed. RESULTS: In adjuvant RT alone, PALND was significantly related to reduced risk of paraaortic recurrence (0% vs. 17.1%) and distant metastasis (4.5% vs. 19.5%) compared with the no PALND group. PALND affected 5-year DFS (90.2% vs. 58.9%, p = 0.016) and OS (100% vs. 83.1%, p = 0.022). For the CTRT group, the paraaortic recurrence rate was 19.5% for the no PALND group and 12.8% for the PALND group (p = 0.682). Of patients who underwent PALND in the CTRT group, less extensive PALND was significantly related to increased paraaortic recurrence (≤10 vs. >10 dissected LNs, 17.1% vs. 0%). In the no PALND group (n = 82), 5-year paraaortic-recurrence free survival was 79.4% for the CTRT group and 76.2% for the RT alone group (p = 0.941). In multivariate analysis, PALND was significantly associated with reduced risk of disease-specific death (HR, 0.50; 95% CI, 0.26-0.96; p = 0.037). CONCLUSION: PALND provided excellent paraaortic control and improved outcome in stage IIIC1 endometrial cancer with favorable tumor features treated with adjuvant RT alone. Less extensive PALND was associated with significantly increased paraaortic recurrence in patients with advanced tumor features treated with adjuvant CTRT. Combined CTRT did not affect disease control in the paraaortic region compared with RT alone.
Authors: Nicole Concin; Carien L Creutzberg; Ignace Vergote; David Cibula; Mansoor Raza Mirza; Simone Marnitz; Jonathan A Ledermann; Tjalling Bosse; Cyrus Chargari; Anna Fagotti; Christina Fotopoulou; Antonio González-Martín; Sigurd F Lax; Domenica Lorusso; Christian Marth; Philippe Morice; Remi A Nout; Dearbhaile E O'Donnell; Denis Querleu; Maria Rosaria Raspollini; Jalid Sehouli; Alina E Sturdza; Alexandra Taylor; Anneke M Westermann; Pauline Wimberger; Nicoletta Colombo; François Planchamp; Xavier Matias-Guiu Journal: Virchows Arch Date: 2021-02 Impact factor: 4.064
Authors: Nick M Spirtos; Danielle Enserro; Howard D Homesley; Susan K Gibbons; David Cella; Robert T Morris; Koen DeGeest; Roger B Lee; David S Miller Journal: Gynecol Oncol Date: 2019-04-30 Impact factor: 5.482
Authors: Francesco Multinu; Jennifer A Ducie; Ane Gerda Zahl Eriksson; Brooke A Schlappe; William A Cliby; Gretchen E Glaser; Tommaso Grassi; Gary L Keeney; Amy L Weaver; Nadeem R Abu-Rustum; Mario M Leitao; Andrea Mariani Journal: Gynecol Oncol Date: 2019-10-08 Impact factor: 5.482