Radiat Oncol J.  2017 Dec;35(4):349-358. 10.3857/roj.2017.00367.

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

• Oh J
• Seol KH
• Lee HJ
• Choi YS
• Park JY
• Bae JY

• KMID: 2401789
• DOI: http://doi.org/10.3857/roj.2017.00367

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 paraaortic 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.

Keyword

Uterine cervical neoplasm; Lymph node; Radiotherapy; Survival rate

MeSH Terms

Chemoradiotherapy
Disease-Free Survival
Drug Therapy*
Follow-Up Studies
Humans
Lymph Nodes
Magnetic Resonance Imaging
Neoplasm Metastasis
Radiotherapy
Recurrence
Survival Rate
Uterine Cervical Neoplasms*