Mauro Geovanne Pedro, de Aquino Calheiros Vinicius, Vonsowski Matheus Sorgi, Avelar Talita, de Andrade Carvalho Heloisa
Department of Radiology and Oncology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil.
Santa Cruz Oncology Center, Santa Cruz Japanese Hospital, São Paulo, SP, Brazil.
Rep Pract Oncol Radiother. 2023 Jul 25;28(3):332-339. doi: 10.5603/RPOR.a2023.0036. eCollection 2023.
Since the GOG125 study, treating radically patients with positive para-aortic lymph nodes has been a valid approach. Nevertheless, literature lacks data on how to better treat these patients since they are usually excluded from trials. In this study, we aimed to report the outcomes of patients with advanced cervical cancer and positive para-aortic lymph nodes (PAN) treated in a single tertiary/academic institution and try to identify variables that may impact survival.
We retrospectively reviewed patients with positive para-aortic lymph nodes treated in our institution. Demographic variables and treatment options were assessed and their impact on overall survival (OS), locorregional control, distant metastasis free survival, and para-aortic lymph node progression was analyzed.
We assessed 65 patients treated from April 2010 to May 2017. Median OS was 38.7 months. Median locorregional and para-aortic progression free survivals were not reached. Median distant metastasis progression-free survival was 64.3 months. Better ECOG performance status (p > 0.001), concurrent chemotherapy (p = 0.031), and brachytherapy (p = 0.02) were independently related to better overall survival.
Patients with current stage IIIC2 cervix cancer may present long term survival. Treating positive PAN cervical cancer patients with concurrent chemoradiation including brachytherapy with curative intent should be standard. Poor PS and more advanced pelvic disease may represent a higher risk for worse outcomes. Distant metastases are still a challenge for disease control.
自GOG125研究以来，对主动脉旁淋巴结阳性的患者进行根治性治疗一直是一种有效的方法。然而，由于这些患者通常被排除在试验之外，文献中缺乏关于如何更好地治疗这些患者的数据。在本研究中，我们旨在报告在单一三级/学术机构接受治疗的晚期宫颈癌和主动脉旁淋巴结阳性（PAN）患者的结局，并试图确定可能影响生存的变量。
我们回顾性分析了在本机构接受治疗的主动脉旁淋巴结阳性患者。评估了人口统计学变量和治疗选择，并分析了它们对总生存（OS）、局部区域控制、无远处转移生存和主动脉旁淋巴结进展的影响。
我们评估了2010年4月至2017年5月期间接受治疗的65例患者。中位OS为38.7个月。未达到中位局部区域和主动脉旁无进展生存时间。中位无远处转移进展生存时间为64.3个月。较好的东部肿瘤协作组（ECOG）体能状态（p>0.001）、同步化疗（p=0.031）和近距离放疗（p=0.02）与更好的总生存独立相关。
目前IIIC2期宫颈癌患者可能有长期生存。对PAN阳性的宫颈癌患者采用包括根治性近距离放疗在内的同步放化疗应作为标准治疗。较差的体能状态和更晚期的盆腔疾病可能预示预后较差的风险更高。远处转移仍然是疾病控制的一个挑战。
