Radiation Oncology/Cervix/Para-aortic Recurrence

Para-Aortic Lymph Node Recurrence

Fractionated Radiation

• MD Anderson; 2009 (2002-2008) PMID 19922641 -- "Reirradiation to the abdomen for gastrointestinal malignancies." (Hague W, Radiat Oncol. 2009 Nov 18;4:55. doi: 10.1186/1748-717X-4-55.)
  • Retrospective. 13 patients, prior abdominal radiation (median 45 Gy), re-irradiation for recurrent or metastatic GI malignancies. Median interval 26 months. RT given 1.5 Gy BID, median dose 30 Gy (24-48 Gy). Concurrent chemotherapy 62%
  • Outcome: 1-year LC 50%; median duration of control 15 months.
  • Toxicity: 1 patient Grade 4 late GI bleeding
  • Conclusion: HyperFX accelerated re-irradiation to the abdomen well tolerated; could play a role in providing limited duration local control

• Multi-institutional, Japan; 2006 (1994-2003) PMID 17126206 -- "Multi-institutional study of radiation therapy for isolated para-aortic lymph node recurrence in uterine cervical carcinoma: 84 subjects of a population of more than 5,000." (Niibe Y, Int J Radiat Oncol Biol Phys. 2006 Dec 1;66(5):1366-9.)
  • Retrospective. 13 Japanese hospitals. 84 patients with isolated para-aortic recurrence. Treated with RT, 1.7-2.0 Gy/fx. Mean dose 50.8 Gy (25-60 Gy)
  • Outcome: 3-year OS 50%, 5-year OS 31%; if symptoms present 3-year OS 27% vs 56%. By dose, <≤ 50 Gy 43% vs >50 Gy 58% (p=0.07)
  • Toxicity: no Grade 3 toxicity
  • Conclusion: RT for isolated para-aortic recurrence could have significant impact on survival

• Chungnam National University, South Korea; 2003 (1997-2000) PMID 12654434 -- "Hyperfractionated radiotherapy with concurrent chemotherapy for para-aortic lymph node recurrence in carcinoma of the cervix." (Kim JS, Int J Radiat Oncol Biol Phys. 2003 Apr 1;55(5):1247-53.)
  • Retrospective. 12 patients, isolated PALN recurrence, who had prior radiation. Current field top of T12 to L5/S1. Fractionated dose 1.2 Gy BID, medial total dose 60 Gy. Weekly concurrent paclitaxel or cisplatin.
  • Outcome: 3-year OS 19%; median OS 21 months. If initial relapse <24 months, OS 13 months vs 45 months (SS)
  • Toxicity: Grade 3+ hematlogic toxicity in 17%; Grade 2 nausea 50%. No late GI or neurologic complications
  • Concousion: Hyperfractionated RT with concurrent chemotherapy effective, without significant toxicity

SBRT

• Rozzano, Italy; 2011 2006-2009) PMID 20800375 -- "Clinical outcome of hypofractionated stereotactic radiotherapy for abdominal lymph node metastases" (Bignardi M, Int J Radiat Oncol Biol Phys. 2011 Nov 1;81(3):831-8. doi: 10.1016/j.ijrobp.2010.05.032. Epub 2010 Aug 26.)
  • Retrospective. 19 patients, various tumors, SBRT 45 Gy in 6 fractions; downscaled in 6/19 patients due to volume constrains. Constraints: spine <18 Gy, total kidney V15 <35%, duodenum V36 <1%, stomach/bowel V36 <1%, liver V15 < 700 cm3. Median F/U 1 year
  • Outcome: 2-year LC 78%; LR 2/19, both had distant progression also. 2-year PFS 20%. Number of metastases only predictor for PFS
  • Toxicity: "minimal"
  • Conclusion: SBRT to abdominal lymph nodes is feasible, with good clinical results