Para-aortic Radiation
Treatment of Para-aortic node
- 45 Gy with chemotherapy is tolerable in phase II trials
Elective Para-aortic node treatment
Summary
- 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.
page revision: 4, last edited: 24 Sep 2007 20:00