Journal Article

Does external beam radiation boost to pelvic lymph nodes improve outcomes in patients with locally advanced cervical cancer?

Choo, Bok Ai, Ng, Joseph, Shen, Liang, Koh, Vicky, Low, Jeffrey J. H., Wujanto, Caryn, Ilancheran, Arunachalam, Tan, David, Tang, Johann

2019

Overview

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 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 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 EBRT boost to pelvic lymph nodes does not reduce recurrence or improve survival in locally advanced cervical cancer with lymph node involvement at diagnosis.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Adult / Aged / Biomedical and Life Sciences / Biomedicine / Biopsy / Brachytherapy / Cancer patients / Cancer Research / Cancer therapies / Cancer treatment / Care and treatment / CAT scans / Cervical cancer / Chemoradiotherapy - methods / Chemotherapy / Diagnostic imaging / Female / Health aspects / Health Promotion and Disease Prevention / Histology / Humans / Lymph nodes / Lymph Nodes - diagnostic imaging / Lymph Nodes - pathology / Lymph Nodes - radiation effects / Lymphatic Metastasis / Lymphatic system / Magnetic Resonance Imaging / Medical and radiation oncology / Medical imaging / Medical prognosis / Medicine/Public Health / Metastasis / Middle Aged / Mortality / Neoplasm Recurrence, Local - diagnostic imaging / Neoplasm Recurrence, Local - drug therapy / Neoplasm Recurrence, Local - pathology / Neoplasm Recurrence, Local - radiotherapy / NMR / Nuclear magnetic resonance / Obstetrics / Oncology / Patient outcomes / Pelvic node / Pelvis - diagnostic imaging / Pelvis - pathology / Pelvis - radiation effects / Planning / Positron emission tomography / Radiation boost / Radiation therapy / Radiotherapy / Radiotherapy Dosage / Recurrence (Disease) / Research Article / Risk factors / Surgical Oncology / Survival / Tomography, X-Ray Computed / Toxicity / Uterine Cervical Neoplasms - diagnostic imaging / Uterine Cervical Neoplasms - drug therapy / Uterine Cervical Neoplasms - pathology / Uterine Cervical Neoplasms - radiotherapy