340 Para-aortic lymph node staging or extended field radiation therapy for locally advanced cervical cancer: can we overcome the initial propagation of disease?

Introduction/Background To evaluate clinical outcomes of node positive cervical cancer in the modern era of surgical staging, PET-CT, EBRT and IGABT. Methodology Patients with histologically proven cervical cancer (FIGO 2018 stage IB-IVA), staged by PET-CT or para-aortic lymph node dissection treated at our institution between 2017 and 2021 were reviewed Results One hundred patients with LACC FIGO 2018 stages (IB: 24%, II: 24%, IIIA: 2%, IIIB: 5%, IIIC1: 32%, IIIC2: 10%, IVA: 3%) were treated by definitive CRT and IGABT. Forty-two patients had nodal metastasis at the time of diagnosis, 21 were staged by surgery with an upstaging for 2 patients (9.5%) and 21 patients had image staging (PET-CT).The time between the initial biopsy and the start of the CRT were 73± 53 days and 56.7± 61.8 days in the patients underwent surgical vs. image staging respectively (p=0.048). With a median follow-up of 33.8 (95% CI confidence interval: 29–38.4%) months, distant metastatic relapse was observed in 24% of tpatients (16 occurred in the FIGO IIIC1-IIIC2 stage), with four relapses in the para-aortic region in patients underwent extended field irradiation. Local relapse was observed in 5% of patients. The estimated 3-year metastasis-free survival (MFS), disease-free survival (DFS) and overall survival (OS) for the entire population were 75% (95% CI: 65–83%), 70% (95% CI: 60–78%) and 86% (95% CI: 79–92%) respectively. Comparing surgical vs image staging for FIGO IIIC1-IIIC2, MFS and DFS were significantly better in surgical group (p=0.0015) and (p=0.0041) respectively. Non-significant difference was found in terms of OS (p=0.052). Acute toxicity grade ≥3 was present in three patients. High-grade late toxicity (grade ≥3) was reported in 10 patients Conclusion Either, surgical staging or extended field irradiation allows PAN control of disease. Due to the initial propagation of disease and the high incidence of distant metastasis, neodjuvant treatments to overcome this prognosis are needed. Disclosures The authors report no conflict of interest.