Impact of surgical staging in locally advanced cervical cancer and subsequent chemotherapy

Marana, Heitor Ricardo Cosiski; Andrade, Jurandyr Moreira de; Reis, Francisco José Cândido dos; Tiezzi, Daniel Guimarães; Zola, Fábio Eduardo; Clagnan, Willian Simões; Garieri, Alexandre Pavan

doi:10.1002/jso.21360

Cited by 8 publications

(8 citation statements)

References 27 publications

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“…Our results suggested that the response of lymph nodes to RT was a more significant predictive factor for PLN control than size of lymph node before RT or dose of external radiation. In several reports on lymphadenectomy for advanced cervical cancer, 39-45 % patients had PLN metastases [13][14][15]. In the current study, only 31.8% patients had PLN metastases based on our criteria.…”

Section: Discussioncontrasting

confidence: 49%

“…Several researchers have reported that 39-44% of patients with advanced cervical cancer have pelvic lymph node (PLN) metastases (based on lymphadenectomy) [13][14][15]. However, as many lymph node metastases cannot be detected by computed tomography (CT) or magnetic resonance imaging (MRI), RT for locally advanced cervical cancer includes prophylactic irradiation to the PLN area as standard radiation therapy for advanced cervical cancer.…”

Section: Introductionmentioning

confidence: 99%

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Impact of Boost Irradiation on Pelvic Lymph Node Control in Patients with Cervical Cancer

Wakatsuki¹,

Ohno

Kato

et al. 2012

International Journal of Radiation Oncology*Biology*Physics

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Radiation therapy (RT) for metastatic pelvic lymph nodes (PLNs) is not well established in cervical cancer. In this study the correlation between size of lymph nodes and control doses of RT was analyzed. Between January 2002 and December 2007, 245 patients with squamous cell carcinoma of the cervix treated with a combination of external beam irradiation with or without boost irradiation and high-dose rate brachytherapy were investigated. Size of lymph node was measured by computed tomography before RT and just after 50 Gy RT. Of the 245 patients, 78 had PLN metastases, and a total of 129 had enlarged PLNs diagnosed as metastases; 22 patients had PLN failure. The PLN control rate at 5 years was 79.5% for positive cases and 95.8% for negative cases. In cases with positive PLNs, 12 of 129 nodes (9.3%) developed recurrences. There was significant correlation between PLN control rate and size of PLN after 50 Gy (<10 mm: 96.7%, 10 mm: 75.7 % (P<0.001)). In addition, the recurrence in these poor-response nodes was significantly correlated with dose of RT. Nine of 16 nodes receiving ≤ 58 Gy had recurrence, but none of 21 nodes receiving > 58 Gy had recurrence (P = 0.0003). These results suggested that the response of lymph nodes after RT was a more significant predictive factor for recurrence than size of lymph node before RT, and poor-response lymph nodes might require boost irradiation at a total dose of > 58 Gy.

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Section: Discussioncontrasting

confidence: 49%

Section: Introductionmentioning

confidence: 99%

Impact of Boost Irradiation on Pelvic Lymph Node Control in Patients with Cervical Cancer

Wakatsuki¹,

Ohno

Kato

et al. 2012

International Journal of Radiation Oncology*Biology*Physics

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“…In the present study, the predominant failure for node-positive patients was distant metastases, especially in PANs. Marana et al [16] reported that surgical debulking achieved significantly improved OS (surgical debulking, 80.6%; non-surgical treatment, 51.1%; P = 0.001). In contrast, Cheung et al [7] and Kupet et al [17] indicated that surgical debulking did not have a positive effect on the OS.…”

Section: Discussionmentioning

confidence: 99%

“…Hacker et al [5] reported that severe late complications occurred in six patients (18%); five of these complications were small bowel obstructions, and one patient developed ischemic bowel in the distribution of the superior mesenteric artery necessitating resection of the small bowel and a duodenocolic anastomosis. Marana et al [16] also indicated that 9 of 36 patients (25%) had late complications.…”

Section: Discussionmentioning

confidence: 99%

External beam boost irradiation for clinically positive pelvic nodes in patients with uterine cervical cancer

Ariga

Toita

Kasuya

et al. 2013

Journal of Radiation Research

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The purpose of this study was to retrospectively analyze the treatment results of boost external beam radiotherapy (EBRT) to clinically positive pelvic nodes in patients with uterine cervical cancer. The study population comprised 174 patients with FIGO stages 1B1–4A cervical cancer who were treated with definitive radiotherapy (RT) or concurrent chemoradiotherapy (CCRT) and high-dose-rate intracavitary brachytherapy (HDR-ICBT). Patients with positive para-aortic or common iliac nodes (≥10 mm in the shortest diameter, as evaluated by CT/MRI) were ineligible for the study. Fifty-seven patients (33%) had clinically positive pelvic nodes. The median maximum diameter of the nodes was 15 mm (range, 10–60 mm) and the median number of positive lymph nodes was two (range, one to four). Fifty-two of 57 patients (91%) with positive nodes were treated with boost EBRT (6–10 Gy in three to five fractions). The median prescribed dose of EBRT for nodes was 56 Gy. The median follow-up time for all patients was 66 months (range, 3–142 months). The 5-year overall survival rate, disease-free survival rate and pelvic control rate for patients with positive and negative nodes were 73% and 92% (P = 0.001), 58% and 84% (P < 0.001), and 83% and 92% (P = 0.082), respectively. Five of 57 node-positive patients (9%) developed pelvic node recurrences. All five patients with nodal failure had concomitant cervical failure and/or distant metastases. No significant difference was observed with respect to the incidence or severity of late complications by application of boost EBRT. The current retrospective study demonstrated that boost EBRT to positive pelvic nodes achieves favorable nodal control without increasing late complications.

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“…Several researchers have reported that 39–44% of patients with advanced cervical cancer have pelvic lymph node (PLN) metastases (based on lymphadenectomy) [13–15]. However, as many lymph node metastases cannot be detected by computed tomography (CT) or magnetic resonance imaging (MRI), RT for locally advanced cervical cancer includes prophylactic irradiation to the PLN area as standard radiation therapy for advanced cervical cancer.…”

Section: Introductionmentioning

confidence: 99%

Impact of boost irradiation on pelvic lymph node control in patients with cervical cancer

Wakatsuki¹,

Ohno

Kato

et al. 2013

Journal of Radiation Research

View full text Add to dashboard Cite

Radiation therapy (RT) for metastatic pelvic lymph nodes (PLNs) is not well established in cervical cancer. In this study the correlation between size of lymph nodes and control doses of RT was analyzed. Between January 2002 and December 2007, 245 patients with squamous cell carcinoma of the cervix treated with a combination of external beam irradiation with or without boost irradiation and high-dose rate brachytherapy were investigated. Size of lymph node was measured by computed tomography before RT and just after 50 Gy RT. Of the 245 patients, 78 had PLN metastases, and a total of 129 had enlarged PLNs diagnosed as metastases; 22 patients had PLN failure. The PLN control rate at 5 years was 79.5% for positive cases and 95.8% for negative cases. In cases with positive PLNs, 12 of 129 nodes (9.3%) developed recurrences. There was significant correlation between PLN control rate and size of PLN after 50 Gy (<10 mm: 96.7%, ≥ 10 mm: 75.7 % (P<0.001)). In addition, the recurrence in these poor-response nodes was significantly correlated with dose of RT. Nine of 16 nodes receiving ≤ 58 Gy had recurrence, but none of 21 nodes receiving > 58 Gy had recurrence (P = 0.0003). These results suggested that the response of lymph nodes after RT was a more significant predictive factor for recurrence than size of lymph node before RT, and poor-response lymph nodes might require boost irradiation at a total dose of > 58 Gy.

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Impact of surgical staging in locally advanced cervical cancer and subsequent chemotherapy

Abstract: SS in cervical cancer is a feasible and safe pretreatment procedure, and when associated with CT, it improves OS and DFS.

Cited by 8 publications

References 27 publications

Impact of Boost Irradiation on Pelvic Lymph Node Control in Patients with Cervical Cancer

Impact of Boost Irradiation on Pelvic Lymph Node Control in Patients with Cervical Cancer

External beam boost irradiation for clinically positive pelvic nodes in patients with uterine cervical cancer

Impact of boost irradiation on pelvic lymph node control in patients with cervical cancer

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