Incidence and Outcomes of Para-aortic Nodal Recurrence After Definitive Treatment for Cervical Cancer: A Single Institution Experience from South India

Purpose To analyse the patterns of para-aortic nodal recurrence in carcinoma cervix and the outcomes with various treatment options at our institution. Methods The data of patients diagnosed to have cervical cancer between January 2012 and December 2017 were retrieved from the electronic medical records. Those with para-aortic recurrence following definitive treatment for cervical cancer were identified and were classified as isolated para-aortic nodal recurrence, para-aortic and pelvic recurrences, and para-aortic and distant metastases. Analysis was done based on demographic characteristics, disease stage at diagnosis, pathological characteristics, treatment modality, and follow-up. Results There were 18 isolated para-aortic recurrences (41%), 17 para-aortic with distant metastasis (39%), and 9 para-aortic with pelvic metastasis (20%). The median time to recurrence from diagnosis for isolated para-aortic recurrences, para-aortic with pelvic recurrences, and para-aortic with distant metastasis was 26 months, 14 months, and 12.5 months, respectively. The median survival of the entire cohort of patients was 36 months. The median survival of isolated para-aortic recurrence, para-aortic with pelvic recurrence, and para-aortic with distant metastasis was 45 months, 16 months, and 10 months, respectively ( p = 0.001). The median survival was 45 months for those who received combined modality treatment with chemotherapy followed by RT, followed by 30 months for those who received RT alone, and 11 months for those who received chemo alone. For patients who received best supportive care alone, it was 7 months ( p = 0.055). Conclusion Isolated para-aortic recurrences present late and have a relatively favourable prognosis when treated with a combined modality approach. At recurrence, definitive para-aortic radiation therapy combined with chemotherapy had the best outcome. High-risk approach with prophylactic lower para-aortic radiation for high volume primary and pelvic nodal disease needs to be studied for further improvement in outcomes.