Dados do Trabalho

Título

Curative treatment for stage IIIC2 cervical cancer: what to expect?

Introdução

Radical treatment of patients with uterine cervix cancer and positive para-aortic lymph nodes is a valid approach. In this regard, the Federatión Internationale de Gynecologie et Obstetrice (FIGO) staging has changed in 2018.

Objetivo

To evaluate overall survival (OS), pelvic disease-free survival (PDFS), paraortic lymph node progression (PANP) and distant metastases-free survival (DMFS) of patients submitted to radical treatment for uterine cervix cancer FIGO stage IIIC2.

Método

Retrospective analysis of a single institution cohort. Inclusion criteria were biopsy proven cervical cancer and positive paraortic lymph nodes (IIIC2) in staging computed tomography, characterized as nodes larger than 1cm in any diameter. Three-year minimum follow-up was required. Radiotherapy (RT) and chemotherapy followed the institutional protocol: 45-50.4Gy to pelvic and para-aortic fields, with a boost up to 60Gy to macroscopic nodal disease. If brachytherapy was indicated, 4 fractions of 7-7.5Gy to point A were delivered. If not, a boost to primary site would be done up to 59.4Gy. Concurrent chemotherapy, when delivered, was with weekly cisplatin (40mg/m2). Demographic and treatment data were collected. OS, PDFS, PANP and DMFS were assessed from the first day of RT. Uni and multivariate analysis were performed.

Resultados

From April 2010 to May 2017, 65 patients were included. Mean age was 53 years, 83.1% presented ECOG performance status (PS) 0 or 1, 90.8% had squamous cell carcinoma. Mean RT dose was 55.4Gy. Concomitant chemotherapy was delivered in 67.7% of the patients and 67.7% were submitted to brachytherapy. With a median follow-up of 31.6 months, mean overall survival was 53.9 months (1.8–102.9), with 35 deaths, most (77.1%) in the first 20 months of follow-up. Three and five-year OS, PDFS, PANP, and DMFS were respectively, 50.6% and 41.3%, 70.8% and 65.3%, 17.3% and 20.4%, 59.6% and 54.7%. In the univariate analysis, the variables that significantly (p<0.05) influenced the outcomes were: ECOG-PS (OS, DMFS), advanced T stage (T4) (OS, PDFS, DMFS), hydronephrosis (OS, PDFS, DMFS), brachytherapy (OS, DMFS) and concomitant chemotherapy (OS, PANP). No independent variable was selected in the multivariate analysis.

Conclusão

Stage IIIC2 cervix cancer patients should be treated with curative intent, since long-term disease control and survival may be expected. Poor PS and more advanced pelvic disease may represent negative prognostic factors. Distant metastases are still a challenge for disease control.

Palavras-chave

Cervical cancer; Retroperitoneal lymph node; Radiotherapy