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Impact of primary para-aortic lymphadenectomy on distant failure in locally advanced cervical cancer patients treated in the era of image-guided adaptive brachytherapy

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Abstract

To investigate the impact of a primary para-aortic lymphadenectomy (PAL) in locally advanced cervical cancer patients receiving definitive chemoradiation, we reviewed the clinical records of consecutive patients treated in our Institution and receiving an external beam irradiation followed with an image-guided adaptive brachytherapy for a locally advanced cervical cancer. We examined the impact of performing a primary PAL as part of primary staging for guiding irradiation fields in patients without extra-pelvic PET uptake. The outcome of patients presenting para-aortic lymph node uptake (PALNU) was also examined. 186 patients were identified. Median follow-up was 44.4 months. Patients receiving a primary PAL (PAL group) and those who received upfront pelvic chemoradiation (no-PAL group) did not significantly differ for loco-regional failures. Survival without distant failure (DFFS), including para-aortic relapses, was at 3 years 87 % (95 % CI 84–90 %) in PAL group, 67 % (95 % CI 59–85 %) in the no-PAL group and 44 % (95 % CI 32–66 %) in the PALNU group (p = 0.04 for comparison between PAL and no-PAL groups). In a multivariate model including para-aortic lymphadenectomy, pelvic nodal uptake and high-risk clinical target volume as adjustment variables, a para-aortic lymphadenectomy was significant for DFS (HR = 0.47, 95 % CI 0.26–0.84, p = 0.01). Although confounding factors could account for these retrospective results, a primary PAL with tailored irradiation fields based on para-aortic histological findings seems to be associated with a better control for distant metastases. A randomized trial is testing the benefit of this strategy.

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Authors and Affiliations

  1. Brachytherapy Unit, Gustave Roussy, 114 rue Edouard Vaillant, 94800, Villejuif, France

    Cyrus Chargari, Renaud Mazeron, Claire Petit, Pierre Maroun, Pierre Annede & Christine Haie-Meder

  2. INSERM1030, Gustave Roussy Cancer Campus, Villejuif, France

    Cyrus Chargari & Eric Deutsch

  3. Radiotherapy Department, Gustave Roussy, Villejuif, France

    Cyrus Chargari, Renaud Mazeron, Claire Petit, Pierre Maroun, Pierre Annede, Eric Deutsch & Christine Haie-Meder

  4. Effets biologiques des rayonnements, Institut de Recherche Biomédicale des Armées, Bretigny-sur-Orge, France

    Cyrus Chargari

  5. Biostatistics and Epidemiology Unit, Gustave Roussy, Villejuif, France

    Ariane Dunant

  6. Department of Surgery, Gustave Roussy, Villejuif, France

    Sébastien Gouy, Catherine Uzan, Enrica Bentivegna & Philippe Morice

  7. Department of Radiology, Gustave Roussy, Villejuif, France

    Corinne Balleyguier

  8. Department of Pathology, Gustave Roussy, Villejuif, France

    Catherine Genestie

  9. Department of Medical Oncology, Gustave Roussy, Villejuif, France

    Patricia Pautier, Alexandra Leary & Catherine Lhomme

  10. Faculte de Médecine, University Paris-Sud, SIRIC SOCRATES, Le Kremlin-Bicetre, France

    Eric Deutsch

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  1. Cyrus Chargari
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  2. Renaud Mazeron
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Correspondence to Cyrus Chargari.

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Chargari, C., Mazeron, R., Dunant, A. et al. Impact of primary para-aortic lymphadenectomy on distant failure in locally advanced cervical cancer patients treated in the era of image-guided adaptive brachytherapy. Clin Exp Metastasis 33, 775–785 (2016). https://doi.org/10.1007/s10585-016-9817-7

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  • DOI: https://doi.org/10.1007/s10585-016-9817-7

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