Risk factors for nodal failure after radiochemotherapy and image guided brachytherapy in locally advanced cervical cancer: An EMBRACE analysis

Abstract

This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

Upstaging by para-aortic lymph node dissection in patients with locally advanced cervical cancer: A systematic review and meta-analysis

“…Extending pelvic radiotherapy fields to the PALN region in patients with no suspicious PALNs has not been studied in a modern randomized trial. Such 'prophylactic' PALN irradiation resulted in improved progression-free survival in some cohort studies [38,39], but not in others [40,41], and its role is therefore not clearly established.…”

Optimal prophylactic para-aortic radiotherapy in locally advanced cervical cancer: anatomy-based versus margin-based delineation

“…Prophylactic para-aortic radiotherapy can effectively mitigate the risk of para-aortic nodal failure,3–8 and we found that anatomy-based definition of the para-aortic nodal region may further optimize treatment outcomes of prophylactic para-aortic radiotherapy. However, distant failures were the main patterns of failure in our study, which is in line with a previous large study 23.…”

“…External beam radiotherapy was delivered by intensity-modulated radiotherapy using 6 or 10 MV photons in all patients. At our institutions, prophylactic extended-field radiotherapy was administered to patients with common iliac or multiple pelvic lymph nodes (≥3 pelvic lymph nodes), bulky tumors (size ≥5 cm), or FIGO stage IIIA–B disease 2–6. Prophylactic extended-field intensity-modulated radiotherapy was performed at 45 Gy in 25 fractions.…”

“…Concurrent chemoradiotherapy is the current standard treatment for locally advanced cervical cancer 1. Patients with common iliac or multiple pelvic lymph nodes or bulky tumors are at higher risk of para-aortic nodal metastasis 2–5. Prophylactic para-aortic radiotherapy can effectively mitigate the risk of para-aortic nodal recurrence in these patients 6–10.…”

The role of proton therapy in gynecological radiation oncology

“…A significant opportunity to improve normal tissue toxicity with proton therapy in gynecologic malignancies is the use of proton therapy to treat para-aortic disease in extended-field radiotherapy. In cervical cancer, for example, there is renewed attention to treatment of the para-aortic nodes, given that PET/CT scanning may potentially not detect a quarter of para-aortic nodes involved; additionally, involvement of three or more pelvic lymph nodes or the common iliac nodes increases risk of para-aortic node involvement 39. Treatment of these nodal regions is challenging given significant amounts of bowel, kidney, spine, and other exposed organs.…”