Radiation Oncology Journal

The Korean Society for Radiation Oncology (대한방사선종양학회)
권호 표지
DOI QR코드

DOI QR Code

Prophylactic extended-field irradiation with concurrent chemotherapy for pelvic lymph node-positive cervical cancer

  • Oh, Jinju (Department of Obstetrics and Gynecology, Catholic University of Daegu School of Medicine) ;
  • Seol, Ki Ho (Department of Radiation Oncology, Catholic University of Daegu School of Medicine) ;
  • Lee, Hyun Joo (Department of Obstetrics and Gynecology, Catholic University of Daegu School of Medicine) ;
  • Choi, Youn Seok (Department of Obstetrics and Gynecology, Catholic University of Daegu School of Medicine) ;
  • Park, Ji Y. (Department of Pathology, Catholic University of Daegu School of Medicine) ;
  • Bae, Jin Young (Department of Obstetrics and Gynecology, Catholic University of Daegu School of Medicine)
  • Received : 2017.07.10
  • Accepted : 2017.09.01
  • Published : 2017.12.31
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: This study aimed to evaluate whether prophylactic extended-field pelvic radiotherapy (EF-PRT) yields better results than standard whole pelvic radiotherapy (WPRT) in patients with pelvic lymph node-positive cervical cancer treated with concurrent chemoradiotherapy (CCRT). Materials and Methods: A total of 126 cases of stage IB-IVA cervical cancer that had pelvic lymph node involvement in magnetic resonance imaging and were treated with CCRT between 2000 and 2016 were reviewed. None of the patients had para-aortic lymph node (PALN) metastases. The patients were classified to two groups, namely, those treated with EF-PRT, including prophylactic para-aortic radiotherapy, and those treated only with WPRT. The median dose to the PALN area in patients treated with EF-PRT was 45 Gy. All patients received concurrent cisplatin-based chemotherapy. Results: Overall, 52 and 74 patients underwent EF-PRT and WPRT, respectively. Patient characteristics and irradiated dose were not significantly different, except the dose to the para-aortic area, between the two groups. The median follow-up period was 75.5 months (range, 5 to 195 months). The 10-year cumulative recurrence rate of PALN for EF-PRT vs. WPRT was 6.9% and 10.1% (p = 0.421), respectively. The 10-year disease-free survival and overall survival for EF-PRT vs. WPRT were 69.7% vs. 66.1% (p = 0.748) and 71.7% vs. 72.3% (p = 0.845), respectively. Acute gastrointestinal complications were significantly higher in EF-PRT (n = 21; 40.4%) than WPRT (n = 26; 35.1%) (p = 0.046). Late toxicities were not significantly different in both groups. Conclusion: In this study, prophylactic radiotherapy for PALN does not have an additional benefit in patients with pelvic lymph node-positive cervical cancer treated with CCRT.

Keywords

References

  1. Sevin BU, Lu Y, Bloch DA, Nadji M, Koechli OR, Averette HE. Surgically defined prognostic parameters in patients with early cervical carcinoma: a multivariate survival tree analysis. Cancer 1996;78:1438-46. https://doi.org/10.1002/(SICI)1097-0142(19961001)78:7<1438::AID-CNCR10>3.0.CO;2-0
  2. Yalman D, Aras AB, Ozkok S, et al. Prognostic factors in definitive radiotherapy of uterine cervical cancer. Eur J Gynaecol Oncol 2003;24:309-14.
  3. Tseng JY, Yen MS, Twu NF, et al. Prognostic nomogram for overall survival in stage IIB-IVA cervical cancer patients treated with concurrent chemoradiotherapy. Am J Obstet Gynecol 2010;202:174.e1-7. https://doi.org/10.1016/j.ajog.2009.09.028
  4. Kidd EA, Siegel BA, Dehdashti F, et al. Lymph node staging by positron emission tomography in cervical cancer: relationship to prognosis. J Clin Oncol 2010;28:2108-13. https://doi.org/10.1200/JCO.2009.25.4151
  5. Berman ML, Keys H, Creasman W, DiSaia P, Bundy B, Blessing J. Survival and patterns of recurrence in cervical cancer metastatic to periaortic lymph nodes (a Gynecologic Oncology Group study). Gynecol Oncol 1984;19:8-16. https://doi.org/10.1016/0090-8258(84)90151-3
  6. Ring KL, Young JL, Dunlap NE, Andersen WA, Schneider BF. Extended-field radiation therapy with whole pelvis radiotherapy and cisplatin chemosensitization in the treatment of IB2-IIIB cervical carcinoma: a retrospective review. Am J Obstet Gynecol 2009;201:109.e1-6. https://doi.org/10.1016/j.ajog.2009.03.022
  7. Sakuragi N, Satoh C, Takeda N, et al. Incidence and distribution pattern of pelvic and paraaortic lymph node metastasis in patients with Stages IB, IIA, and IIB cervical carcinoma treated with radical hysterectomy. Cancer 1999;85:1547-54. https://doi.org/10.1002/(SICI)1097-0142(19990401)85:7<1547::AID-CNCR16>3.0.CO;2-2
  8. Michel G, Morice P, Castaigne D, Leblanc M, Rey A, Duvillard P. Lymphatic spread in stage Ib and II cervical carcinoma: anatomy and surgical implications. Obstet Gynecol 1998;91:360-3. https://doi.org/10.1016/S0029-7844(97)00696-0
  9. Lagasse LD, Creasman WT, Shingleton HM, Ford JH, Blessing JA. Results and complications of operative staging in cervical cancer: experience of the Gynecologic Oncology Group. Gynecol Oncol 1980;9:90-8. https://doi.org/10.1016/0090-8258(80)90013-X
  10. Gouy S, Morice P, Narducci F, et al. Nodal-staging surgery for locally advanced cervical cancer in the era of PET. Lancet Oncol 2012;13:e212-20. https://doi.org/10.1016/S1470-2045(12)70011-6
  11. Rotman M, Choi K, Guse C, Marcial V, Hornback N, John M. Prophylactic irradiation of the para-aortic lymph node chain in stage IIB and bulky stage IB carcinoma of the cervix, initial treatment results of RTOG 7920. Int J Radiat Oncol Biol Phys 1990;19:513-21. https://doi.org/10.1016/0360-3016(90)90475-Y
  12. Rotman M, Sedlis A, Piedmonte MR, et al. A phase III randomized trial of postoperative pelvic irradiation in Stage IB cervical carcinoma with poor prognostic features: follow-up of a gynecologic oncology group study. Int J Radiat Oncol Biol Phys 2006;65:169-76. https://doi.org/10.1016/j.ijrobp.2005.10.019
  13. Joiner M, Bentzen S. Fractionation: the linear-quadratic approach. In: Joiner M, van der Kogel A, editors. Basic clinical radiobiology. 4th ed. London: Hodder Arnold; 2009. p. 102-33.
  14. Haie C, Pejovic MH, Gerbaulet A, et al. Is prophylactic paraaortic irradiation worthwhile in the treatment of advanced cervical carcinoma? Results of a controlled clinical trial of the EORTC radiotherapy group. Radiother Oncol 1988;11:101-12. https://doi.org/10.1016/0167-8140(88)90245-9
  15. Morris M, Eifel PJ, Lu J, et al. Pelvic radiation with concurrent chemotherapy compared with pelvic and para-aortic radiation for high-risk cervical cancer. N Engl J Med 1999;340:1137-43. https://doi.org/10.1056/NEJM199904153401501
  16. Rose PG, Bundy BN, Watkins EB, et al. Concurrent cisplatinbased radiotherapy and chemotherapy for locally advanced cervical cancer. N Engl J Med 1999;340:1144-53. https://doi.org/10.1056/NEJM199904153401502
  17. Whitney CW, Sause W, Bundy BN, et al. Randomized comparison of fluorouracil plus cisplatin versus hydroxyurea as an adjunct to radiation therapy in stage IIB-IVA carcinoma of the cervix with negative para-aortic lymph nodes: a Gynecologic Oncology Group and Southwest Oncology Group study. J Clin Oncol 1999;17:1339-48. https://doi.org/10.1200/JCO.1999.17.5.1339
  18. Wong LC, Ngan HY, Cheung AN, Cheng DK, Ng TY, Choy DT. Chemoradiation and adjuvant chemotherapy in cervical cancer. J Clin Oncol 1999;17:2055-60. https://doi.org/10.1200/JCO.1999.17.7.2055
  19. Eifel PJ, Winter K, Morris M, et al. Pelvic irradiation with concurrent chemotherapy versus pelvic and para-aortic irradiation for high-risk cervical cancer: an update of radiation therapy oncology group trial (RTOG) 90-01. J Clin Oncol 2004;22:872-80. https://doi.org/10.1200/jco.2004.22.14_suppl.872
  20. Malfetano JH, Keys H, Cunningham MJ, Gibbons S, Ambros R. Extended field radiation and cisplatin for stage IIB and IIIB cervical carcinoma. Gynecol Oncol 1997;67:203-7. https://doi.org/10.1006/gyno.1997.4865
  21. Chung YL, Jian JJ, Cheng SH, et al. Extended-field radiotherapy and high-dose-rate brachytherapy with concurrent and adjuvant cisplatin-based chemotherapy for locally advanced cervical cancer: a phase I/II study. Gynecol Oncol 2005;97:126-35. https://doi.org/10.1016/j.ygyno.2004.12.039
  22. Gerszten K, Colonello K, Heron DE, et al. Feasibility of concurrent cisplatin and extended field radiation therapy (EFRT) using intensity-modulated radiotherapy (IMRT) for carcinoma of the cervix. Gynecol Oncol 2006;102:182-8. https://doi.org/10.1016/j.ygyno.2005.12.044
  23. Uno T, Mitsuhashi A, Isobe K, et al. Concurrent daily cisplatin and extended-field radiation therapy for carcinoma of the cervix. Int J Gynecol Cancer 2008;18:80-4. https://doi.org/10.1111/j.1525-1438.2007.00960.x
  24. Grigsby PW, Heydon K, Mutch DG, Kim RY, Eifel P. Long-term follow-up of RTOG 92-10: cervical cancer with positive paraaortic lymph nodes. Int J Radiat Oncol Biol Phys 2001;51:982-7. https://doi.org/10.1016/S0360-3016(01)01723-0
  25. Park SG, Kim JH, Oh YK, et al. Is Prophylactic irradiation to para-aortic lymph nodes in locally advanced cervical cancer necessary? Cancer Res Treat 2014;46:374-82. https://doi.org/10.4143/crt.2013.084
  26. Yap ML, Cuartero J, Yan J, et al. The role of elective para-aortic lymph node irradiation in patients with locally advanced cervical cancer. Clin Oncol (R Coll Radiol) 2014;26:797-803. https://doi.org/10.1016/j.clon.2014.08.008
  27. Asiri MA, Tunio MA, Mohamed R, et al. Is extended-field concurrent chemoradiation an option for radiologic negative paraaortic lymph node, locally advanced cervical cancer? Cancer Manag Res 2014;6:339-48.
  28. Lee J, Lin JB, Chang CL, et al. Prophylactic lower para-aortic irradiation using intensity-modulated radiotherapy mitigates the risk of para-aortic recurrence in locally advanced cervical cancer: a 10-year institutional experience. Gynecol Oncol 2017;146:20-6. https://doi.org/10.1016/j.ygyno.2017.04.016
  29. Sapienza LG, Gomes MJ, Calsavara VF, Leitao MM Jr, Baiocchi G. Does para-aortic irradiation reduce the risk of distant metastasis in advanced cervical cancer? A systematic review and meta-analysis of randomized clinical trials. Gynecol Oncol 2017;144:312-7. https://doi.org/10.1016/j.ygyno.2016.11.044

Cited by

  1. Prophylactic Extended-Field Irradiation for Patients With Cervical Cancer Treated With Concurrent Chemoradiotherapy : A Propensity-Score Matching Analysis vol.28, pp.8, 2017, https://doi.org/10.1097/igc.0000000000001344
  2. Radiochemotherapie des Zervixkarzinoms vol.25, pp.6, 2017, https://doi.org/10.1007/s00761-019-0575-4
  3. Radiochemotherapie oder operative Therapie bei Zervixkarzinom - was und zu welcher Zeit? vol.52, pp.8, 2017, https://doi.org/10.1007/s00129-019-4463-1
  4. Prophylactic Extended-Field Irradiation in Patients With Cervical Cancer: A Literature Review vol.10, pp.None, 2017, https://doi.org/10.3389/fonc.2020.579410
  5. Who can benefit from a lymph node boost in definitive chemoradiotherapy for node-positive cervical cancer: an evaluation of nodal failure in patients without nodal boost vol.61, pp.3, 2017, https://doi.org/10.1093/jrr/rraa012
  6. Significance of para-aortic lymph node evaluation in patients with FIGO IIIC1 cervical cancer vol.50, pp.10, 2017, https://doi.org/10.1093/jjco/hyaa091