Cervical carcinoma metastatic to para-aortic nodes: Extended field radiation therapy with concomitant 5-fluorouracil and cisplatin chemotherapy: A Gynecologic Oncology Group Study

Purpose: A multicenter trial of chemoradiation therapy to evaluate the feas ibility of extended field radiation therapy (ERT) with 5-fluorouracil (5-FU ) and cisplatin, and to determine the progression-free interval (PFI), over all survival (OS), and recurrence sites in patients with biopsy-confirmed p ara-aortic node metastases (PAN) from cervical carcinoma. Methods and Materials: Ninety-five patients with cervical carcinoma and PAN metastases were entered and 86 were evaluable: Stage I-14, Stage II-40, St age III-27, Stage IVA-5. Seventy-nine percent of the patients were followed for 5 or more years or died. ERT doses were 4500 cGy (PAN), 3960 cGy to th e pelvis (Stages IB/IIB), and 4860 cGy to the pelvis (Stages IIIB/IVA). Poi nt A intracavitary (IC) doses were 4000 cGy (Stages IB/IIB), and 3000 cGy ( Stages IIIB/IVA). Point B doses were raised to 6000 cGy (ERT + IC) with par ametrial boost. Concomitant chemotherapy consisted of 5-FU 1000 mg/m(2)/day for 96 hours and cisplatin 50 mg/m(2) in weeks 1 and 5. Results: Eighty-five of 86 patients completed radiation therapy and 90% of patients completed both courses of chemotherapy. Gynecologic Oncology Group (GOG) grade 3-4 acute toxicity were gastrointestinal (18.6%) and hematolog ic (15.1%). Late morbidity actuarial risk of 14% at 4 years primarily invol ved the rectum. Initial sites of recurrence were pelvis alone, 20.9%; dista nt metastases only, 31.4%; and pelvic plus distant metastases, 10.5%. The 3 -year OS and PFI rate were 39% and 34%, respectively, for the entire group. OS was Stage I-50%, Stage II-39%, and Stage III/IVA-38%. Conclusions: Extended field radiation therapy with 5-FU and cisplatin chemo therapy was feasible in a multicenter clinical trial. PFI of 33% at 3 years suggests that a proportion of patients achieve control of advanced pelvic disease and that not all patients with PAN metastases have systemic disease . This points to the importance of assessment and treatment of PAN metastas es. (C) 1998 Elsevier Science Inc.