Long-term results of maximally aggressive trimodality therapy in a high-risk subset of early-stage cervical cancer patients

Kevin S. Elliott, Mark E. Borowsky, Edmond S. Malka, Sidney A. Scudder, Gary S. Leiserowitz, Anthony H. Russell

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

OBJECTIVE: To evaluate the long-term survival and treatment-related morbidity associated with treating patients who have early-stage cervical carcinoma metastatic to the paraaortic lymph nodes with radical hysterectomy, pelvic and paraaortic lymphadenectomy, and adjuvant, extended field chemoradiation with cisplatin and 5-fluorouracil (5-FU). STUDY DESIGN: From 1988 to 1997, 14 consecutive patients referred to Radiological Associates of Sacramento following radical hysterectomy and pelvic and paraaortic lymphadenectomy with findings of clinical stage IB or IIA cervical cancer and histologically confirmed lymph node metastasis to the common iliac or paraaortic distributions were treated with adjuvant, extended field chemoradiation utilizing prolonged infusion 5-FU and bolus cisplatin. Retrospective chart review was performed, and survival and morbidity information were analyzed. Recurrence was assessed among patients based on age, race, total number of nodes involved, gross vs. microscopic nodal involvement, squamous vs. nonsquamous tumor histology, time to initiation of adjuvant treatment and time required to complete that treatment. Calculated 5-year survival, mean survival, morbidity type and incidence are reported for the group as a whole. RESULTS: Calculated 5-year survival of patients in this series was 38% by life table analysis. Median survival was 4.4 years; 50% of patients had a recurrence. None of the examined parameters were significant predictors of recurrence. There was 1 treatment-related death and a second case of severe treatment-related morbidity (radiation enteritis requiring colostomy and bilateral ureteral stenosis requiring bilateral nephrostomies). There were 6 cases of minor treatment-related toxicity occurring in 5 of 14 (36%) treated patients. CONCLUSION: In general, survival in the current series of patients was akin to that in clinically similar patients treated with chemoradiation alone. Morbidity among our patients was significant. In the presence of positive paraaortic lymph nodes there were no independent predictors of recurrence among the pathologic or treatment parameters examined.

Original languageEnglish (US)
Pages (from-to)383-388
Number of pages6
JournalJournal of Reproductive Medicine for the Obstetrician and Gynecologist
Volume51
Issue number5
StatePublished - May 2006

Fingerprint

Uterine Cervical Neoplasms
Survival
Morbidity
Recurrence
Therapeutics
Lymph Nodes
Lymph Node Excision
Hysterectomy
Fluorouracil
Cisplatin
Life Tables
Colostomy
Enteritis
Histology
Pathologic Constriction
Radiation
Neoplasm Metastasis
Carcinoma
Incidence

Keywords

  • Cervical cancer
  • Chemotherapy
  • Radiotherapy

ASJC Scopus subject areas

  • Obstetrics and Gynecology
  • Reproductive Medicine

Cite this

Long-term results of maximally aggressive trimodality therapy in a high-risk subset of early-stage cervical cancer patients. / Elliott, Kevin S.; Borowsky, Mark E.; Malka, Edmond S.; Scudder, Sidney A.; Leiserowitz, Gary S.; Russell, Anthony H.

In: Journal of Reproductive Medicine for the Obstetrician and Gynecologist, Vol. 51, No. 5, 05.2006, p. 383-388.

Research output: Contribution to journalArticle

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abstract = "OBJECTIVE: To evaluate the long-term survival and treatment-related morbidity associated with treating patients who have early-stage cervical carcinoma metastatic to the paraaortic lymph nodes with radical hysterectomy, pelvic and paraaortic lymphadenectomy, and adjuvant, extended field chemoradiation with cisplatin and 5-fluorouracil (5-FU). STUDY DESIGN: From 1988 to 1997, 14 consecutive patients referred to Radiological Associates of Sacramento following radical hysterectomy and pelvic and paraaortic lymphadenectomy with findings of clinical stage IB or IIA cervical cancer and histologically confirmed lymph node metastasis to the common iliac or paraaortic distributions were treated with adjuvant, extended field chemoradiation utilizing prolonged infusion 5-FU and bolus cisplatin. Retrospective chart review was performed, and survival and morbidity information were analyzed. Recurrence was assessed among patients based on age, race, total number of nodes involved, gross vs. microscopic nodal involvement, squamous vs. nonsquamous tumor histology, time to initiation of adjuvant treatment and time required to complete that treatment. Calculated 5-year survival, mean survival, morbidity type and incidence are reported for the group as a whole. RESULTS: Calculated 5-year survival of patients in this series was 38{\%} by life table analysis. Median survival was 4.4 years; 50{\%} of patients had a recurrence. None of the examined parameters were significant predictors of recurrence. There was 1 treatment-related death and a second case of severe treatment-related morbidity (radiation enteritis requiring colostomy and bilateral ureteral stenosis requiring bilateral nephrostomies). There were 6 cases of minor treatment-related toxicity occurring in 5 of 14 (36{\%}) treated patients. CONCLUSION: In general, survival in the current series of patients was akin to that in clinically similar patients treated with chemoradiation alone. Morbidity among our patients was significant. In the presence of positive paraaortic lymph nodes there were no independent predictors of recurrence among the pathologic or treatment parameters examined.",
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AU - Borowsky, Mark E.

AU - Malka, Edmond S.

AU - Scudder, Sidney A.

AU - Leiserowitz, Gary S.

AU - Russell, Anthony H.

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