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

Abstract

PurposeThis 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 MethodsA 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.ResultsOverall, 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.ConclusionIn this study, prophylactic radiotherapy for PALN does not have an additional benefit in patients with pelvic lymph node-positive cervical cancer treated with CCRT.

Prophylactic Extended-Field Irradiation for Patients With Cervical Cancer Treated With Concurrent Chemoradiotherapy: A Propensity-Score Matching Analysis

“…No survival differences were observed between the 2 groups. 13 In the study by Oh et al, 14 74 patients with cervical cancer were treated with pelvic RT and 52 patients underwent extended-field RT. The 10-year DFS, OS, and cumulative PALNF rates were not significantly different between the 2 groups.…”

“…The 10-year DFS, OS, and cumulative PALNF rates were not significantly different between the 2 groups. 14 A study from Canada conducted multivariate analysis for 228 patients with cervical cancer and found that extended-field RT was not significantly associated with DFS, OS, and para-aortic relapse. 15 …”

“…The indication of prophylactic extended-field RT is also inconclusive. In previous studies, the inclusion criteria for extended-field RT included locally advanced cervical cancer, 11 , 13 patients with pelvic MLNs, 12 , 14 , 16 FIGO stage IB or IIA with primary tumor of 4 cm or greater, or FIGO stage IIB. 9 As shown in Table 1 , in our institute, patients treated with extended-field RT were more likely to have younger age, more advanced stage, larger primary tumor size, and more extensive pelvic MLNs.…”

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.…”

“…The eligibility criteria differ between studies on prophylactic EFI, and the criteria include cervical cancer ( 33 , 35 ), LACC ( 37 , 40 ), FIGO stage IB-IVA ( 34 ), FIGO stage IIB-IVA ( 32 ), and pelvic LN involvement ( 36 , 40 , 47 ), among others. This is an important reason why these studies have contradictory results.…”