Impact of paraaortic lymphadenectomy for endometrial cancer with positive pelvic lymph nodes: A Korean Radiation Oncology Group study (KROG 13-17)
| Autor: | M.S. Yoon, W. Park, S.J. Huh, H.J. Kim, Y.S. Kim, Y.B. Kim, J.-Y. Kim, J.-H. Lee, J. Cha, J.H. Kim, J. Kim, W.S. Yoon, J.H. Choi, M. Chun, Y. Choi, S.K. Chang, K.K. Lee, M. Kim, J.-U. Jeong, T.-K. Nam |
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| Rok vydání: | 2016 |
| Předmět: |
Adult
Oncology medicine.medical_specialty medicine.medical_treatment Gastroenterology Pelvis 03 medical and health sciences 0302 clinical medicine Paraaortic lymph nodes Internal medicine medicine Carcinoma Humans 030212 general & internal medicine Stage (cooking) Aged business.industry Endometrial cancer Chemoradiotherapy General Medicine Middle Aged medicine.disease Endometrial Neoplasms Dissection Lymphatic Metastasis 030220 oncology & carcinogenesis Lymph Node Excision Female Radiotherapy Adjuvant Surgery Lymphadenectomy business Adjuvant |
| Zdroj: | European Journal of Surgical Oncology (EJSO). 42:1497-1505 |
| ISSN: | 0748-7983 |
| Popis: | Aim We investigated the role of paraaortic lymph node dissection (PALND) in patients with stage IIIC1 endometrial carcinoma after surgery followed by adjuvant radiotherapy (RT) alone or chemoradiotherapy (CTRT). Methods We performed a subgroup analysis in 151 patients treated with adjuvant pelvic RT. Paraaortic-recurrence free survival, disease-free survival (DFS) and overall survival (OS) were analyzed. Results In adjuvant RT alone, PALND was significantly related to reduced risk of paraaortic recurrence (0% vs. 17.1%) and distant metastasis (4.5% vs. 19.5%) compared with the no PALND group. PALND affected 5-year DFS (90.2% vs. 58.9%, p = 0.016) and OS (100% vs. 83.1%, p = 0.022). For the CTRT group, the paraaortic recurrence rate was 19.5% for the no PALND group and 12.8% for the PALND group (p = 0.682). Of patients who underwent PALND in the CTRT group, less extensive PALND was significantly related to increased paraaortic recurrence (≤10 vs. >10 dissected LNs, 17.1% vs. 0%). In the no PALND group (n = 82), 5-year paraaortic-recurrence free survival was 79.4% for the CTRT group and 76.2% for the RT alone group (p = 0.941). In multivariate analysis, PALND was significantly associated with reduced risk of disease-specific death (HR, 0.50; 95% CI, 0.26–0.96; p = 0.037). Conclusion PALND provided excellent paraaortic control and improved outcome in stage IIIC1 endometrial cancer with favorable tumor features treated with adjuvant RT alone. Less extensive PALND was associated with significantly increased paraaortic recurrence in patients with advanced tumor features treated with adjuvant CTRT. Combined CTRT did not affect disease control in the paraaortic region compared with RT alone. |
| Databáze: | OpenAIRE |
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