Impact of paraaortic lymphadenectomy for endometrial cancer with positive pelvic lymph nodes

A Korean Radiation Oncology Group study (KROG 13-17)

M. S. Yoon, W. Park, S. J. Huh, H. J. Kim, Y. S. Kim, Y. B. Kim, J. Y. Kim, J. H. Lee, H. J. Kim, J. Cha, J. H. Kim, J. Kim, Won Sup Yoon, J. H. Choi, M. Chun, Y. Choi, S. K. Chang, K. K. Lee, M. Kim, J. U. Jeong & 1 others T. K. Nam

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Aim We investigated the role of paraaortic lymph node dissection (PALND) in patients with stage IIIC1 endometrial carcinoma after surgery followed by adjuvant radiotherapy (RT) alone or chemoradiotherapy (CTRT). Methods We performed a subgroup analysis in 151 patients treated with adjuvant pelvic RT. Paraaortic-recurrence free survival, disease-free survival (DFS) and overall survival (OS) were analyzed. Results In adjuvant RT alone, PALND was significantly related to reduced risk of paraaortic recurrence (0% vs. 17.1%) and distant metastasis (4.5% vs. 19.5%) compared with the no PALND group. PALND affected 5-year DFS (90.2% vs. 58.9%, p = 0.016) and OS (100% vs. 83.1%, p = 0.022). For the CTRT group, the paraaortic recurrence rate was 19.5% for the no PALND group and 12.8% for the PALND group (p = 0.682). Of patients who underwent PALND in the CTRT group, less extensive PALND was significantly related to increased paraaortic recurrence (≤10 vs. >10 dissected LNs, 17.1% vs. 0%). In the no PALND group (n = 82), 5-year paraaortic-recurrence free survival was 79.4% for the CTRT group and 76.2% for the RT alone group (p = 0.941). In multivariate analysis, PALND was significantly associated with reduced risk of disease-specific death (HR, 0.50; 95% CI, 0.26–0.96; p = 0.037). Conclusion PALND provided excellent paraaortic control and improved outcome in stage IIIC1 endometrial cancer with favorable tumor features treated with adjuvant RT alone. Less extensive PALND was associated with significantly increased paraaortic recurrence in patients with advanced tumor features treated with adjuvant CTRT. Combined CTRT did not affect disease control in the paraaortic region compared with RT alone.

Original languageEnglish
Pages (from-to)1497-1505
Number of pages9
JournalEuropean Journal of Surgical Oncology
Volume42
Issue number10
DOIs
Publication statusPublished - 2016 Oct 1

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Radiation Oncology
Endometrial Neoplasms
Lymph Node Excision
Lymph Nodes
Adjuvant Radiotherapy
Recurrence
Disease-Free Survival
Survival
Radiotherapy
Adjuvant Chemoradiotherapy
Neoplasms
Multivariate Analysis

Keywords

  • Endometrial cancer
  • Extended-field RT
  • Lymphadenectomy
  • Paraaortic recurrence

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

Impact of paraaortic lymphadenectomy for endometrial cancer with positive pelvic lymph nodes : A Korean Radiation Oncology Group study (KROG 13-17). / Yoon, M. S.; Park, W.; Huh, S. J.; Kim, H. J.; Kim, Y. S.; Kim, Y. B.; Kim, J. Y.; Lee, J. H.; Kim, H. J.; Cha, J.; Kim, J. H.; Kim, J.; Yoon, Won Sup; Choi, J. H.; Chun, M.; Choi, Y.; Chang, S. K.; Lee, K. K.; Kim, M.; Jeong, J. U.; Nam, T. K.

In: European Journal of Surgical Oncology, Vol. 42, No. 10, 01.10.2016, p. 1497-1505.

Research output: Contribution to journalArticle

Yoon, MS, Park, W, Huh, SJ, Kim, HJ, Kim, YS, Kim, YB, Kim, JY, Lee, JH, Kim, HJ, Cha, J, Kim, JH, Kim, J, Yoon, WS, Choi, JH, Chun, M, Choi, Y, Chang, SK, Lee, KK, Kim, M, Jeong, JU & Nam, TK 2016, 'Impact of paraaortic lymphadenectomy for endometrial cancer with positive pelvic lymph nodes: A Korean Radiation Oncology Group study (KROG 13-17)', European Journal of Surgical Oncology, vol. 42, no. 10, pp. 1497-1505. https://doi.org/10.1016/j.ejso.2016.07.003
Yoon, M. S. ; Park, W. ; Huh, S. J. ; Kim, H. J. ; Kim, Y. S. ; Kim, Y. B. ; Kim, J. Y. ; Lee, J. H. ; Kim, H. J. ; Cha, J. ; Kim, J. H. ; Kim, J. ; Yoon, Won Sup ; Choi, J. H. ; Chun, M. ; Choi, Y. ; Chang, S. K. ; Lee, K. K. ; Kim, M. ; Jeong, J. U. ; Nam, T. K. / Impact of paraaortic lymphadenectomy for endometrial cancer with positive pelvic lymph nodes : A Korean Radiation Oncology Group study (KROG 13-17). In: European Journal of Surgical Oncology. 2016 ; Vol. 42, No. 10. pp. 1497-1505.
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title = "Impact of paraaortic lymphadenectomy for endometrial cancer with positive pelvic lymph nodes: A Korean Radiation Oncology Group study (KROG 13-17)",
abstract = "Aim We investigated the role of paraaortic lymph node dissection (PALND) in patients with stage IIIC1 endometrial carcinoma after surgery followed by adjuvant radiotherapy (RT) alone or chemoradiotherapy (CTRT). Methods We performed a subgroup analysis in 151 patients treated with adjuvant pelvic RT. Paraaortic-recurrence free survival, disease-free survival (DFS) and overall survival (OS) were analyzed. Results In adjuvant RT alone, PALND was significantly related to reduced risk of paraaortic recurrence (0{\%} vs. 17.1{\%}) and distant metastasis (4.5{\%} vs. 19.5{\%}) compared with the no PALND group. PALND affected 5-year DFS (90.2{\%} vs. 58.9{\%}, p = 0.016) and OS (100{\%} vs. 83.1{\%}, p = 0.022). For the CTRT group, the paraaortic recurrence rate was 19.5{\%} for the no PALND group and 12.8{\%} for the PALND group (p = 0.682). Of patients who underwent PALND in the CTRT group, less extensive PALND was significantly related to increased paraaortic recurrence (≤10 vs. >10 dissected LNs, 17.1{\%} vs. 0{\%}). In the no PALND group (n = 82), 5-year paraaortic-recurrence free survival was 79.4{\%} for the CTRT group and 76.2{\%} for the RT alone group (p = 0.941). In multivariate analysis, PALND was significantly associated with reduced risk of disease-specific death (HR, 0.50; 95{\%} CI, 0.26–0.96; p = 0.037). Conclusion PALND provided excellent paraaortic control and improved outcome in stage IIIC1 endometrial cancer with favorable tumor features treated with adjuvant RT alone. Less extensive PALND was associated with significantly increased paraaortic recurrence in patients with advanced tumor features treated with adjuvant CTRT. Combined CTRT did not affect disease control in the paraaortic region compared with RT alone.",
keywords = "Endometrial cancer, Extended-field RT, Lymphadenectomy, Paraaortic recurrence",
author = "Yoon, {M. S.} and W. Park and Huh, {S. J.} and Kim, {H. J.} and Kim, {Y. S.} and Kim, {Y. B.} and Kim, {J. Y.} and Lee, {J. H.} and Kim, {H. J.} and J. Cha and Kim, {J. H.} and J. Kim and Yoon, {Won Sup} and Choi, {J. H.} and M. Chun and Y. Choi and Chang, {S. K.} and Lee, {K. K.} and M. Kim and Jeong, {J. U.} and Nam, {T. K.}",
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TY - JOUR

T1 - Impact of paraaortic lymphadenectomy for endometrial cancer with positive pelvic lymph nodes

T2 - A Korean Radiation Oncology Group study (KROG 13-17)

AU - Yoon, M. S.

AU - Park, W.

AU - Huh, S. J.

AU - Kim, H. J.

AU - Kim, Y. S.

AU - Kim, Y. B.

AU - Kim, J. Y.

AU - Lee, J. H.

AU - Kim, H. J.

AU - Cha, J.

AU - Kim, J. H.

AU - Kim, J.

AU - Yoon, Won Sup

AU - Choi, J. H.

AU - Chun, M.

AU - Choi, Y.

AU - Chang, S. K.

AU - Lee, K. K.

AU - Kim, M.

AU - Jeong, J. U.

AU - Nam, T. K.

PY - 2016/10/1

Y1 - 2016/10/1

N2 - Aim We investigated the role of paraaortic lymph node dissection (PALND) in patients with stage IIIC1 endometrial carcinoma after surgery followed by adjuvant radiotherapy (RT) alone or chemoradiotherapy (CTRT). Methods We performed a subgroup analysis in 151 patients treated with adjuvant pelvic RT. Paraaortic-recurrence free survival, disease-free survival (DFS) and overall survival (OS) were analyzed. Results In adjuvant RT alone, PALND was significantly related to reduced risk of paraaortic recurrence (0% vs. 17.1%) and distant metastasis (4.5% vs. 19.5%) compared with the no PALND group. PALND affected 5-year DFS (90.2% vs. 58.9%, p = 0.016) and OS (100% vs. 83.1%, p = 0.022). For the CTRT group, the paraaortic recurrence rate was 19.5% for the no PALND group and 12.8% for the PALND group (p = 0.682). Of patients who underwent PALND in the CTRT group, less extensive PALND was significantly related to increased paraaortic recurrence (≤10 vs. >10 dissected LNs, 17.1% vs. 0%). In the no PALND group (n = 82), 5-year paraaortic-recurrence free survival was 79.4% for the CTRT group and 76.2% for the RT alone group (p = 0.941). In multivariate analysis, PALND was significantly associated with reduced risk of disease-specific death (HR, 0.50; 95% CI, 0.26–0.96; p = 0.037). Conclusion PALND provided excellent paraaortic control and improved outcome in stage IIIC1 endometrial cancer with favorable tumor features treated with adjuvant RT alone. Less extensive PALND was associated with significantly increased paraaortic recurrence in patients with advanced tumor features treated with adjuvant CTRT. Combined CTRT did not affect disease control in the paraaortic region compared with RT alone.

AB - Aim We investigated the role of paraaortic lymph node dissection (PALND) in patients with stage IIIC1 endometrial carcinoma after surgery followed by adjuvant radiotherapy (RT) alone or chemoradiotherapy (CTRT). Methods We performed a subgroup analysis in 151 patients treated with adjuvant pelvic RT. Paraaortic-recurrence free survival, disease-free survival (DFS) and overall survival (OS) were analyzed. Results In adjuvant RT alone, PALND was significantly related to reduced risk of paraaortic recurrence (0% vs. 17.1%) and distant metastasis (4.5% vs. 19.5%) compared with the no PALND group. PALND affected 5-year DFS (90.2% vs. 58.9%, p = 0.016) and OS (100% vs. 83.1%, p = 0.022). For the CTRT group, the paraaortic recurrence rate was 19.5% for the no PALND group and 12.8% for the PALND group (p = 0.682). Of patients who underwent PALND in the CTRT group, less extensive PALND was significantly related to increased paraaortic recurrence (≤10 vs. >10 dissected LNs, 17.1% vs. 0%). In the no PALND group (n = 82), 5-year paraaortic-recurrence free survival was 79.4% for the CTRT group and 76.2% for the RT alone group (p = 0.941). In multivariate analysis, PALND was significantly associated with reduced risk of disease-specific death (HR, 0.50; 95% CI, 0.26–0.96; p = 0.037). Conclusion PALND provided excellent paraaortic control and improved outcome in stage IIIC1 endometrial cancer with favorable tumor features treated with adjuvant RT alone. Less extensive PALND was associated with significantly increased paraaortic recurrence in patients with advanced tumor features treated with adjuvant CTRT. Combined CTRT did not affect disease control in the paraaortic region compared with RT alone.

KW - Endometrial cancer

KW - Extended-field RT

KW - Lymphadenectomy

KW - Paraaortic recurrence

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DO - 10.1016/j.ejso.2016.07.003

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JO - European Journal of Surgical Oncology

JF - European Journal of Surgical Oncology

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