Does external beam radiation boost to pelvic lymph nodes improve outcomes in patients with locally advanced cervical cancer?
Adult
Aged
Brachytherapy
Chemoradiotherapy
/ methods
Female
Humans
Lymph Nodes
/ diagnostic imaging
Lymphatic Metastasis
Magnetic Resonance Imaging
Middle Aged
Neoplasm Recurrence, Local
/ diagnostic imaging
Pelvis
/ diagnostic imaging
Positron-Emission Tomography
Radiotherapy Dosage
Tomography, X-Ray Computed
Uterine Cervical Neoplasms
/ diagnostic imaging
Cervical cancer
Pelvic node
Radiation boost
Radiotherapy
Journal
BMC cancer
ISSN: 1471-2407
Titre abrégé: BMC Cancer
Pays: England
ID NLM: 100967800
Informations de publication
Date de publication:
25 Apr 2019
25 Apr 2019
Historique:
received:
15
07
2018
accepted:
09
04
2019
entrez:
27
4
2019
pubmed:
27
4
2019
medline:
16
8
2019
Statut:
epublish
Résumé
Current recommendation for locally advanced cervical cancer includes pelvic external beam radiation therapy (EBRT) with concurrent chemotherapy followed by brachytherapy. Involvement of pelvic lymph nodes is an important prognostic factor in locally advanced cervical cancer and recurrence commonly occurs despite definitive treatment. To date, there is no standard guideline on whether an EBRT boost should be applied to involved pelvic lymph nodes. Our study aims to assess if pelvic EBRT boost would reduce recurrence, benefit survival, and affect associated toxicities. We conducted a retrospective review of locally advanced cervical cancer cases treated with definitive treatment at our institution. Involvement of pelvic lymph nodes were assessed on CT, MRI (> 10 mm or suspicious features) or PET scan (SUVmax > 2.5). EBRT dose ranged from 45 to 50.4 Gy with nodal boost ranging from 3.6-19.8 Gy. Between 2008 to 2015, 139 patients with locally advanced cervical cancer underwent treatment. Sixty-seven patients had positive pelvic lymph nodes, of which 53.7% received a nodal boost. Five-year recurrence free survival was 48.6% with vs. 64.5% without nodal boost (P = 0.169) and 5-year overall survival in those with positive pelvic lymph nodes was 74.3% with vs. 80.6% without nodal boost (P = 0.143). There was no significant difference in toxicity with nodal boost. EBRT boost to pelvic lymph nodes does not reduce recurrence or improve survival in locally advanced cervical cancer with lymph node involvement at diagnosis.
Sections du résumé
BACKGROUND
BACKGROUND
Current recommendation for locally advanced cervical cancer includes pelvic external beam radiation therapy (EBRT) with concurrent chemotherapy followed by brachytherapy. Involvement of pelvic lymph nodes is an important prognostic factor in locally advanced cervical cancer and recurrence commonly occurs despite definitive treatment. To date, there is no standard guideline on whether an EBRT boost should be applied to involved pelvic lymph nodes. Our study aims to assess if pelvic EBRT boost would reduce recurrence, benefit survival, and affect associated toxicities.
METHODS
METHODS
We conducted a retrospective review of locally advanced cervical cancer cases treated with definitive treatment at our institution. Involvement of pelvic lymph nodes were assessed on CT, MRI (> 10 mm or suspicious features) or PET scan (SUVmax > 2.5). EBRT dose ranged from 45 to 50.4 Gy with nodal boost ranging from 3.6-19.8 Gy.
RESULTS
RESULTS
Between 2008 to 2015, 139 patients with locally advanced cervical cancer underwent treatment. Sixty-seven patients had positive pelvic lymph nodes, of which 53.7% received a nodal boost. Five-year recurrence free survival was 48.6% with vs. 64.5% without nodal boost (P = 0.169) and 5-year overall survival in those with positive pelvic lymph nodes was 74.3% with vs. 80.6% without nodal boost (P = 0.143). There was no significant difference in toxicity with nodal boost.
CONCLUSIONS
CONCLUSIONS
EBRT boost to pelvic lymph nodes does not reduce recurrence or improve survival in locally advanced cervical cancer with lymph node involvement at diagnosis.
Identifiants
pubmed: 31023261
doi: 10.1186/s12885-019-5594-4
pii: 10.1186/s12885-019-5594-4
pmc: PMC6485109
doi:
Types de publication
Journal Article
Langues
eng
Pagination
385Références
Radiology. 2001 Mar;218(3):776-82
pubmed: 11230656
J Clin Oncol. 2001 Sep 1;19(17):3745-9
pubmed: 11533097
Gynecol Oncol. 2002 Nov;87(2):163-70
pubmed: 12477446
Int J Radiat Oncol Biol Phys. 2004 Jul 1;59(3):706-12
pubmed: 15183474
Int J Radiat Oncol Biol Phys. 2010 Apr;76(5):1396-403
pubmed: 19581056
J Radiat Res. 2013 Jul 1;54(4):690-6
pubmed: 23365264
J Radiat Res. 2014 Jan 1;55(1):139-45
pubmed: 23912599
J Obstet Gynaecol Res. 2017 Apr;43(4):718-722
pubmed: 28127834
Int J Radiat Oncol Biol Phys. 1995 Nov 1;33(4):843-9
pubmed: 7591892
Radiology. 1994 Mar;190(3):807-11
pubmed: 8115631