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Abstract
Objective: This study aimed to evaluate the oncologic outcomes according to disease burden in uterine cervical cancer patients with metachronous distant metastases.

Methods: Between 2005 and 2015, 163 patients with metachronous distant metastases from uterine cervical cancer after receiving a definitive therapy were evaluated at seven institutions in Korea. Low metastatic burden was defined as less than 5 metastatic sites, whereas high metastatic burden was others. Each metastasis site was divided based on the lymph node (LN) and organs affected. The overall survival (OS) and progression-free survival (PFS) were assessed. Cox proportional hazards models, including other clinical variables, were used to evaluate the survival outcomes.

Results: The median follow-up duration was 22.2 months (range: 0.3-174.8 months). Para-aortic LNs (56.4%), lungs (26.4%), supraclavicular LNs (18.4%), and peritoneum (13.5%) were found to be the common metastasis sites. Among 37 patients with a single metastasis, 17 (45.9%) had LN metastases and 20 (54.1%) had organ metastases. The 1- and 2-year OS rates were 73.9% and 55.0%, respectively, whereas the PFS rates were 67.2% and 42.9%, respectively. SCC Ag after recurrence and high metastatic burden were significant factors affecting the OS (p=0.004 and p<0.001, respectively). Distant organ recurrence, short disease-free interval (≤2 years), and high metastatic burden were unfavorable factors for PFS (p=0.003, p=0.011, and p=0.002, respectively).

Conclusion: A favorable oncologic outcome can be expected by performing salvage treatments in selected patients with a long disease-free interval, low metastatic burden, and/or lymphatic-only metastasis.

Affiliations

Sunmin Park #  1 , Won Park #  2 , Shin Hyung Park  3 , Joo-Young Kim  4 , Jin Hee Kim  5 , Haeyoung Kim  2 , Yeon-Sil Kim  6 , Won Kyung Cho  2 , Won Sup Yoon  7 , Dae Sik Yang  8
1 Department of Radiation Oncology, Korea University Ansan Hospital, Ansan, Korea.
2 Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
3 Department of Radiation Oncology, School of Medicine, Kyungpook National University, Daegu, Korea.
4 Department of Radiation Oncology, Research Institute and Hospital, National Cancer Center, Goyang, Korea.
5 Department of Radiation Oncology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea.
6 Department of Radiation Oncology, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.
7 Department of Radiation Oncology, Korea University Ansan Hospital, Ansan, Korea. irionyws@korea.ac.kr.
8 Department of Radiation Oncology, Guro Hospital Korea University Medical College, Seoul, Korea. irionmphage@korea.ac.kr.
# Contributed equally.