International Journal of Radiation Oncology*Biology*Physics
Clinical investigation: cervixLong-term follow-up of RTOG 92-10: cervical cancer with positive para-aortic lymph nodes
Introduction
The survival outcome of patients with carcinoma of the cervix and positive para-aortic lymph nodes is poor. Retrospective studies of these patients have demonstrated a 5-year survival of about 30% (1). Treatment failures occur in the pelvis, the para-aortic region, and at distant metastatic sites. These failures occur because most patients present with advanced pelvic disease, bulky para-aortic disease, and unrecognized sites of distant metastatic disease at the time of diagnosis.
The rationale for the treatment method chosen for this study was threefold. Hyperfractionated radiotherapy was used to increase the radiation dose to the pelvis and para-aortic regions. Chemotherapy was used to increase the sensitivity of tumor cells in the pelvis and para-aortic regions to irradiation and to act as a cytotoxic agent for micrometastatic disease outside the irradiation portals (2).
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Patient characteristics
Conditions for eligibility for entry onto the study were squamous cell carcinoma, adenosquamous carcinoma, or adenocarcinoma of the cervix with biopsy-proven positive para-aortic lymph nodes. The stage of the patient’s disease could be clinical Stages I, II, III, or IVa, with no evidence of disease outside the pelvis, except to the lumbar para-aortic lymph nodes. Patients were required to be older than 17 years of age, have a Karnofsky performance status ≥60, and have no medical
Results
A total of 30 patients were entered onto the study from August 1992 to February 1995. All 30 patients were eligible and evaluable. The analysis was performed on all data received at RTOG headquarters as of February 2000. Twenty-three patients were dead, and 7 patients were alive. The median follow-up of the 7 patients alive at the time of last follow-up was 57 months.
The pretreatment characteristics of the patients are shown in Table 1. Patient age ranged from 29 to 72 years, with a median of
Discussion
The objectives of this treatment protocol were threefold. The feasibility and tolerance of hyperfractionated external irradiation to the pelvis and para-aortic region and intracavitary brachytherapy and concurrent chemotherapy were determined. The acute and late toxicity of this treatment regime was determined. The possibility of improving pelvic tumor control and distant metastasis was evaluated.
The initial results of this treatment protocol have been reported (2). These results have been
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Twice-daily fractionation of external irradiation with brachytherapy and chemotherapy in carcinoma of the cervix with positive para-aortic lymph nodesPhase II study of the Radiation Therapy Oncology Group 92-10
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