Para-aortic Radiation

Treatment of Para-aortic node

  • 45 Gy with chemotherapy is tolerable in phase II trials

Elective Para-aortic node treatment


  • with chemotherapy
    • elective para-aortic RT not needed per RTOG 9001 randomized trial
  • without chemotherapy
    • IIB, IB2/IIA should receive EFRT to 45 Gy (RTOG 7920)
    • III patients should not receive EFRT (EORTC)

RTOG 9001 randomized trial

  • to IVA disease, stage IB to IIA disease with a tumor diameter > or = 5 cm, or positive pelvic lymph nodes
  • WP 45 + Chemo vs EFRT 45 Gy w/o Chemo
  • Significant reduction in both pelvic and distant relapse with chemoradiation
  • 67% v 41% at 8 years; P <.0001 in favor of chemotherapy arm

Rotman RTOG 7920 randomized trial

  • IIB and bulky IB/IIA, all with clinically negative PAN
  • WP 45 Gy vs EFRT 45 Gy
  • Significant improvement in OS with elective PAN RT (55% v 44%, p=0.02), but without a disease free survival advantage due to
    • lower incidence of distant failure in complete responders
    • better salvage in the complete responders who later failed locally.
  • double major complication rate (4% to 8%) including 2 deaths (3%).

EORTC Randomized trial for stage III patients:

  • no survival benefit to elective PAN RT but double major complications.
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