Management of nodal recurrences of XXXX with IMRT.

@entity1 @entity137 @entity5 @entity1204
OBJECTIVE: Pelvic and paraortic lymph nodal regions are frequent sites of relapse in @entity1 with @entity1204 who have not undergone adjuvant external beam radiation. We investigated outcomes after definitive management of nodal relapses of @entity1204 with intensity modulated radiation therapy (IMRT). METHODS: Between 2002-2012, 38 @entity1 with @entity1204 who had no prior external beam radiation were treated definitively using IMRT for regionally confined pelvic or paraortic nodal recurrences. Thirteen (34%) had chemotherapy prior to radiation, and 21 (55%) received concurrent chemotherapy. The nodal basins were typically treated to 45-50Gy, with a boost to the gross @entity5 to a median total of 64.7Gy (range 59-73Gy). RESULTS: The median overall survival from date of recurrence was 46.1months and the 2-year survival was 71%. @entity1 who received concurrent chemotherapy had a significantly longer median survival (61.9months versus 28.7months, p=0.034). In-field failures were more frequent in @entity1 who received chemotherapy prior to radiation, had a shorter recurrence-free interval, received a lower radiation dose, and had higher @entity5 grade. Three @entity1 (8%) experienced grade 3-4 late gastrointestinal (GI) @entity137 . CONCLUSIONS: Long-term survival can be achieved in @entity1 with nodal recurrences of @entity1204 . The use of concurrent chemotherapy and dose escalation with IMRT as feasible may improve survival for @entity1 with isolated nodal recurrences of @entity1204 .
