Is Prophylactic Irradiation to Para-aortic Lymph Nodes in Locally Advanced Cervical Cancer Necessary?

Abstract

PurposeThis study evaluated the efficacy of extended field irradiation (EFI) in patients with locally advanced cervical cancer without para-aortic nodal involvement.Materials and MethodsA total of 203 patients with locally advanced cervical cancer (International Federation of Gynecology and Obstetrics [FIGO] stage, IB2-IIIB) treated with radiotherapy at Keimyung University Dongsan Medical Center from 1996 to 2010 were retrospectively analyzed. The median patient age was 59 years (range, 29 to 83 years). None of the patients had para-aortic node metastases. Of the 203 patients, 88 underwent EFI and 115 underwent irradiation of the pelvis only. Concurrent chemoradiotherapy (CCRT) was administered to 133 patients. EFI field was used for treatment of 26 patients who received radiotherapy alone and 62 who received CCRT.ResultsThe median follow-up period was 60 months. The 2- and 5-year overall survival (OS) rates were 87.8% and 73.5%, respectively, and the 2- and 5-year disease-free survival rates were 81.7% and 75.0%, respectively, however, no survival differences were observed between the two treatment field groups. EFI tended to increase OS in the radiotherapy alone group, but not in the CCRT group.ConclusionThese findings suggest that EFI does not have a significant effect in patients with locally advanced cervical cancer, especially in patients receiving CCRT. Conduct of additional studies will be required in order to confirm these findings.

Optimal Extent of Prophylactic Irradiation of Para-aortic Lymph Nodes in Patients With Uterine Cervical Cancer

“…The five-year OS rate in the EFRT arms was 67% and 52% in RTOG trial 79-20 and RTOG trial 90-01, respectively [21,23]. Recent institutional series showed 5 year OS rates of 73.5% and 72.4%, respectively [24,25]. The 5 year survival rate in our study was superior to those in the previous studies, suggesting that SEFRT excluding the upper PALN does not significantly compromise PALN control, survival outcomes, and toxicities compared with EFRT.…”

Prophylactic Extended-Field Irradiation in Patients With Cervical Cancer: A Literature Review

“…However, OS and DFS were not significantly different between the two groups ( 34 ). In retrospective studies conducted by Yi et al ( 35 ), Oh et al ( 36 ), Park et al ( 37 ), and Yap et al ( 38 ), patients with cervical cancer did not benefit from prophylactic EFI. In the study by Park et al ( 37 ), 203 patients with LACC were included.…”

“…Prophylactic EFI and pelvic radiotherapy were performed in 88 and 115 patients, respectively. In the pelvic radiotherapy and prophylactic EFI patient groups, the 5-year OS rates were 74.8 and 71.7% ( p = 0.699), respectively, and the DFS rates were 74.5 and 75.8% ( p = 0.668), respectively ( 37 ). It should be noted that in most retrospective studies, the baseline characteristics were not balanced between the two groups.…”

Management of Para-aortic Lymph Node Disease in Patients With Cervical Cancer

“…40 Studies using concurrent chemoradiotherapy (CCRT), the current standard of care in LACC, 10,41,42 did not confirm these findings, 43,44 and subsequent studies focused on the treatment of patients with either radiologically or surgically confirmed PALN disease.…”