Skip to main content
SpringerLink
Log in

Does postoperative prophylactic irradiation of para-aortic lymph nodes reduce the risk of recurrence in uterine cervical cancer with positive pelvic lymph nodes?

  • Original Article
  • Published:
International Journal of Clinical Oncology Aims and scope Submit manuscript

Abstract

Background

In cervical cancer, para-aortic lymph nodes are common sites of metastasis. The purpose of the study was to evaluate the clinical benefits of prophylactic irradiation as postoperative therapy.

Methods

A retrospective cohort study was conducted during 2001–2015 at a single institution. Patients with a high risk of para-aortic lymph nodes recurrence were eligible for this study, and we identified patients who had pelvic lymph node metastasis and underwent radical surgery and concurrent chemo-radiotherapy. As a result, 33 and 46 patients were included in the treatment (prophylactic irradiation) and non-treatment groups, respectively. Baseline differences between the two groups were adjusted with the inverse probability of treatment weighting using propensity scores composed of the independent variables including age, stage, tumor size, pathological findings, lymph node status, and pathological subtypes.

Results

In the 68-month median follow-up period (range 6–178 months), 25 patients experienced recurrence, and 17 patients were dead. After adjustment with the inverse probability of treatment weighting, the recurrence rates tended to decrease in the treatment group, but there was no significant difference between the two groups [treatment vs. non-treatment, 29.4% and 44.3%, respectively; hazard ratio, 0.593 (95% CI 0.320–1.099); P = 0.097]. However, adjusted para-aortic lymph nodes recurrence rates were not significantly different [treatment vs. non-treatment, 7.8% and 11.4%, respectively; odds ratio, 0.660 (95% CI 0.187–2.322); P = 0.558]. Moreover, Kaplan–Meier curves showing post-recurrence survival revealed no significant difference between the two groups (P = 0.141).

Conclusions

Prophylactic para-aortic lymph nodes irradiation did not reduce the risk of recurrence.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Siegel RL, Miller KD, Jemal A (2016) Cancer statistics. CA Cancer J Clin 66(1):7–30

    Article  Google Scholar 

  2. Benedet JL, Odicino F, Maisonneuve P et al (2003) Carcinoma of the cervix uteri. Int J Gynaecol Obstetrics 83(Suppl 1):41–78

    Article  Google Scholar 

  3. Mabuchi S, Isohashi F, Yoshioka Y et al (2010) Prognostic factors for survival in patients with recurrent cervical cancer previously treated with radiotherapy. Int J Gynecol Cancer 20(5):834–840

    Article  PubMed  Google Scholar 

  4. Waggoner SE (2003) Cervical cancer. Lancet 361(9376):2217–2225

    Article  PubMed  Google Scholar 

  5. Morice P, Castaigne D, Pautier P et al (1999) Interest of pelvic and paraaortic lymphadenectomy in patients with stage IB and II cervical carcinoma. Gynecol Oncol 73(1):106–110

    Article  CAS  PubMed  Google Scholar 

  6. Cosin JA, Fowler JM, Chen MD et al (1998) Pretreatment surgical staging of patients with cervical carcinoma: the case for lymph node debulking. Cancer 82(11):2241–2248

    Article  CAS  PubMed  Google Scholar 

  7. Sakuragi N, Satoh C, Takeda N et al (1999) Incidence and distribution pattern of pelvic and paraaortic lymph node metastasis in patients with Stages IB, IIA, and IIB cervical carcinoma treated with radical hysterectomy. Cancer 85(7):1547–1554

    Article  CAS  PubMed  Google Scholar 

  8. Peters WA 3rd, Liu PY, Barrett RJ 2nd et al (2000) Concurrent chemotherapy and pelvic radiation therapy compared with pelvic radiation therapy alone as adjuvant therapy after radical surgery in high-risk early-stage cancer of the cervix. J Clin Oncol 18(8):1606–1613

    Article  CAS  PubMed  Google Scholar 

  9. Angioli R, Plotti F, Aloisi A et al (2015) A randomized controlled trial comparing four versus six courses of adjuvant platinum-based chemotherapy in locally advanced cervical cancer patients previously treated with neo-adjuvant chemotherapy plus radical surgery. Gynecol Oncol 139(3):433–438

    Article  CAS  PubMed  Google Scholar 

  10. Matsuo K, Shimada M, Saito T et al (2018) Risk stratification models for para-aortic lymph node metastasis and recurrence in stage IB-IIB cervical cancer. J Gynecol Oncol 29(1):e11

    Article  PubMed  Google Scholar 

  11. Gold MA, Tian C, Whitney CW et al (2008) Surgical versus radiographic determination of para-aortic lymph node metastases before chemoradiation for locally advanced cervical carcinoma: a Gynecologic Oncology Group Study. Cancer 112(9):1954–1963

    Article  PubMed  Google Scholar 

  12. Asiri MA, Tunio MA, Mohamed R et al (2014) Is extended-field concurrent chemoradiation an option for radiologic negative paraaortic lymph node, locally advanced cervical cancer? Cancer Manag Res 6:339–348

    PubMed  PubMed Central  Google Scholar 

  13. Haie C, Pejovic MH, Gerbaulet A et al (1988) Is prophylactic para-aortic irradiation worthwhile in the treatment of advanced cervical carcinoma? Results of a controlled clinical trial of the EORTC radiotherapy group. Radiother Oncol 11(2):101–112

    Article  CAS  PubMed  Google Scholar 

  14. Rotman M, Pajak TF, Choi K et al (1995) Prophylactic extended-field irradiation of para-aortic lymph nodes in stages IIB and bulky IB and IIA cervical carcinomas. Ten-year treatment results of RTOG 79-20. JAMA 274(5):387–393

    Article  CAS  PubMed  Google Scholar 

  15. Kim JH, Kim JY, Yoon MS et al (2016) Prophylactic irradiation of para-aortic lymph nodes for patients with locally advanced cervical cancers with and without high CA9 expression (KROG 07-01): a randomized, open-label, multicenter, phase 2 trial. Radiother Oncol 120(3):383–389

    Article  CAS  PubMed  Google Scholar 

  16. Rubin DB (2006) Using propensity scores to help design observational studies: application to the tobacco litigation. Matched Sampl Causal Effects 365–382

  17. Austin PC, Stuart EA (2015) Moving towards best practice when using inverse probability of treatment weighting (IPTW) using the propensity score to estimate causal treatment effects in observational studies. Stat Med 34(28):3661–3679

    Article  PubMed  PubMed Central  Google Scholar 

  18. Ureyen I, Aksoy U, Dundar B et al (2014) Does lymph node involvement affect the patterns of recurrence in stage IB cervical cancer? Turk J Med Sci 44(5):844–852

    Article  PubMed  Google Scholar 

  19. Sapienza LG, Gomes MJ, Calsavara VF et al (2017) Does para-aortic irradiation reduce the risk of distant metastasis in advanced cervical cancer? A systematic review and meta-analysis of randomized clinical trials. Gynecol Oncol 144(2):312–317

    Article  PubMed  Google Scholar 

  20. Beriwal S, Gan GN, Heron DE et al (2007) Early clinical outcome with concurrent chemotherapy and extended-field, intensity-modulated radiotherapy for cervical cancer. Int J Radiat Oncol Biol Phys 68(1):166–171

    Article  PubMed  Google Scholar 

  21. Grigsby PW, Heydon K, Mutch DG et al (2001) Long-term follow-up of RTOG 92 – 10: cervical cancer with positive para-aortic lymph nodes. Int J Radiat Oncol Biol Phys 51(4):982–987

    Article  CAS  PubMed  Google Scholar 

  22. Anglemyer A, Horvath HT, Bero L (2014) Healthcare outcomes assessed with observational study designs compared with those assessed in randomized trials. Cochrane Database Syst Rev 4:Mr000034

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Tsuruma-cho 65, Showa-ku, Nagoya, 466-8550, Japan

    Kosuke Yoshida, Hiroaki Kajiyama, Masato Yoshihara, Yoshiki Ikeda, Nobuhisa Yoshikawa, Kimihiro Nishino, Fumi Utsumi, Kaoru Niimi, Shiro Suzuki & Fumitaka Kikkawa

Authors
  1. Kosuke Yoshida
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hiroaki Kajiyama
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Masato Yoshihara
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yoshiki Ikeda
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Nobuhisa Yoshikawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Kimihiro Nishino
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Fumi Utsumi
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Kaoru Niimi
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Shiro Suzuki
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Fumitaka Kikkawa
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hiroaki Kajiyama.

Ethics declarations

Conflict of interest

No author has any conflict of interest.

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Yoshida, K., Kajiyama, H., Yoshihara, M. et al. Does postoperative prophylactic irradiation of para-aortic lymph nodes reduce the risk of recurrence in uterine cervical cancer with positive pelvic lymph nodes?. Int J Clin Oncol 24, 567–574 (2019). https://doi.org/10.1007/s10147-018-1376-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10147-018-1376-2

Keywords

Search

Navigation