2719 - Extended-Field Chemoradiation in Cervical Cancer with PET/CT-Detected Para-Aortic Lymph Node Metastases

10:45am - 12:00pm PT

Hall F

Screen: 1

POSTER

Presenter(s)

Helen Chen, MD, PhD - National Cheng Kung University Hospital, Tainan City, Tainan

H. H. W. Chen¹, T. L. Tsai², Y. H. Lai¹, and Y. H. Wu²; ¹Department of Oncology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan, ²National Cheng Kung University Hospital, Tainan, Taiwan

Purpose/Objective(s): To evaluate clinical outcomes and identify prognostic factors in patients with para-aortic lymph node (PALN)-metastatic cervical cancer detected by PET/CT who were treated with extended-field radiotherapy and concurrent cisplatin-based chemotherapy.

Materials/Methods: This retrospective study included 49 consecutive cervical cancer patients with PALN metastases identified by 18F-FDG PET/CT between 2007 and 2023. All patients were restaged as FIGO stage IIIC2r according to the 2018 FIGO staging system and received extended-field radiotherapy to both the para-aortic and pelvic regions, combined with concurrent cisplatin-based chemotherapy. The Kaplan-Meier method was used to estimate disease-free survival (DFS) and overall survival (OS), while univariate and multivariate analyses were conducted to identify prognostic factors.

Results: Patient ages ranged from 30 to 82 years (median, 56 years). Among survivors, the median follow-up was 6.3 years (range, 1.2–13.5 years). Squamous cell carcinoma was the predominant histologic subtype, observed in 33 patients (67.3%). The median dose delivered to the PALN region was 55.8 Gy (range, 45–64 Gy). Seventeen patients experienced treatment failure: local recurrence occurred in 3 patients (6.1%), distant metastasis in 9 patients (18.4%), and both local and distant failure in 5 patients (10.2%). The estimated 2-year and 5-year DFS rates were 64.2% and 59.6%, respectively, while the corresponding OS rates were 83.2% and 73.4%. Univariate Cox analysis identified a PALN SUVmax >5 as the only significant prognostic factor for DFS (hazard ratio [HR]: 3.82, 95% CI: 1.53–9.52).

Multivariate analysis also confirmed that a PALN SUVmax >5 was an independent predictor of DFS (HR: 5.52, 95% CI: 1.83–12.57).

Conclusion: Extended-field radiotherapy combined with concurrent cisplatin-based chemotherapy is an effective treatment approach for cervical cancer patients with PALN metastases. Notably, a PALN SUVmax >5 is an independent prognostic factor for DFS, whereas the SUVmax of the primary cervical tumor is not predictive.