Clinical outcomes after isolated pelvic failure in cervical cancer patients treated with definitive radiation.
Adult
Aged
Aged, 80 and over
Antineoplastic Combined Chemotherapy Protocols
/ therapeutic use
Aorta
Bone Neoplasms
/ secondary
Brachytherapy
Female
Fluorodeoxyglucose F18
Humans
Hysterectomy
Lung Neoplasms
/ secondary
Lymph Nodes
/ diagnostic imaging
Lymphatic Metastasis
Middle Aged
Neoplasm Recurrence, Local
/ diagnostic imaging
Pelvic Exenteration
Pelvis
Peritoneal Neoplasms
/ secondary
Positron-Emission Tomography
Radiopharmaceuticals
Salvage Therapy
Survival Rate
Uterine Cervical Neoplasms
/ diagnostic imaging
Chemotherapy
Distant control
Patterns of failure
Pelvic exenteration
Radical hysterectomy
Salvage therapy
Journal
Gynecologic oncology
ISSN: 1095-6859
Titre abrégé: Gynecol Oncol
Pays: United States
ID NLM: 0365304
Informations de publication
Date de publication:
06 2019
06 2019
Historique:
received:
18
02
2019
revised:
11
03
2019
accepted:
14
03
2019
pubmed:
25
3
2019
medline:
14
8
2019
entrez:
26
3
2019
Statut:
ppublish
Résumé
To describe clinical outcomes in patients with isolated pelvic failures after definitive radiation treatment for cervical cancer. Cervical cancer patients with isolated pelvic failure after definitive radiation with brachytherapy boost were identified in a tertiary academic center database from 1997 to 2016. All patients received an FDG-PET scan prior to their initial treatment and at the time of their first recurrence. Isolated failures in the cervix or pelvic nodes were biopsy-proven. Distant failure and overall survival (OS) were censored outcomes. Isolated pelvic failure was detected in 67(11%) out of 607 consecutive patients treated with external beam pelvic radiation and brachytherapy boost. The median time to isolated pelvic recurrence was 9 months (range 3-198). Median follow-up time for patients alive after isolated pelvic recurrence was 40 months (range 0.6-183). Of these 67 patients, 28(42%) received salvage surgery, 17(25%) received chemotherapy alone, and 22(33%) received neither surgery nor chemotherapy. The median time to distant failure after isolated pelvic failure was 20 months (95% CI 3-37), with no significant difference between patients treated surgically vs. non-surgically. FDG-avid pelvic and para-aortic nodes at initial presentation were associated with worse distant control after isolated pelvic failure (HR = 3.4, 95% CI 1.0-12). Median OS for patients treated with surgery, chemotherapy alone, and neither surgery nor chemotherapy was 29 months (95% CI 16-41), 12 months (95% CI 3-21), and 3 months (95% CI 1-5), respectively. Patients who have pelvic and para-aortic nodal disease at initial presentation are at higher risk of failing distantly after isolated pelvic failure, which should be considered when counseling patients on aggressive surgical salvage. Surgical salvage was associated with prolonged survival after isolated pelvic failure.
Identifiants
pubmed: 30905434
pii: S0090-8258(19)30297-5
doi: 10.1016/j.ygyno.2019.03.104
pmc: PMC7428083
mid: NIHMS1610422
pii:
doi:
Substances chimiques
Radiopharmaceuticals
0
Fluorodeoxyglucose F18
0Z5B2CJX4D
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Langues
eng
Pagination
530-534Subventions
Organisme : NCI NIH HHS
ID : K12 CA167540
Pays : United States
Organisme : NCI NIH HHS
ID : R01 CA181745
Pays : United States
Organisme : NCI NIH HHS
ID : R21 CA223799
Pays : United States
Informations de copyright
Copyright © 2019 Elsevier Inc. All rights reserved.
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